A new anterior inferior coronal patellar plica. Issue 4 (August 2018)

• Record Type: Journal Article
• Authors: Sadile, Francesco; Bernasconi, Alessio; Maffulli, Nicola
• Is Part Of: Surgeon. Volume 16:Issue 4(2018)
• Page Start: 195
• Page End: 201
• Publication Date: 2018-08
• Subjects: Inferior patellar plica -- Locked knee -- Shelf syndrome -- Bib like plica -- Sneaky plica; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2017.05.003
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Purpose: To date, four synovial plicae are classically described in the knee. We report a previously undescribed new inferior patellar plica, named "bib-like plica" (BLP, referring to its morphology) related to specific symptoms of atypical recurrent anterior knee pain in the presence of a locked or pseudo-locked knee. We describe this anatomical structure, and assess its clinical relevance in daily practice in terms of clinical pattern and long-term follow-up outcome after arthroscopic excision. Methods: We retrospectively reviewed prospectively collected data on 1033 arthroscopic procedures, selecting patients in whom a knee arthroscopy was indicated following recurrent painful episodes of locking or pseudo-locking not explained by traditional imaging or helped by conservative treatment. Visual Analog Scale (VAS), Lysholm knee score, a physical exam and a satisfaction interview were used to evaluate the clinical status at the latest follow-up. Results: We report 12 patients (8 males, 4 females; mean age 34.2 years) in whom a BLP had been identified at arthroscopy. At a mean follow-up of 13.4 years from its excision, the mean VAS and Lysholm knee score were 9.8 and 100 respectively. In all instances, selective removal of the BLP restored a complete painless functional range of motion documented within 2 months, and confirmed at the latest follow-up. No patient reported locking recurrence or pain, or underwent further surgery, and all were satisfied. Conclusions: The BLP, detected in about 1% of knee arthroscopies in our setting, is strongly associated with a recurrent painful locking knee. Arthroscopic removal produces resolution of symptoms.