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Keywords:
Tissue characterisation, Athletic injuries, Computer Applications-Detection, diagnosis, MR, Musculoskeletal system, Musculoskeletal joint, Musculoskeletal bone
Authors:
R. BENCHIMOL1, B. BONNAIRE1, M. WARIN1, G. BOULU1, A. Benchimol1, D. Zeitoun1, J. I. LELLOUCHE1, M. COHEN1, H. DERAMOND2; 1Amiens/FR, 2Amiens /FR
DOI:
10.1594/ecr2014/C-2144
Aims and objectives
Synovial plicae are remnant of the three compartments of the knee during fetal development around 8 week [1][2].
The medial plica courses coronaly on the medial wall of the joint capsule and insert distally on the infrapatellar fat pad (Fig.1).
Medial plica is found in 24% of cadaver in autopsic study,
whereas the frequency is 72% in arthroscopic study [3][4].
Medial plica is also called plica synovialis patellaris,
Iino band,
plica alaris,
synovial shelf,
or patellar meniscus [5].
This synovial fold is usually non symptomatic.
It can become symptomatic causing the medial plica syndrome.
The patient is generally young,
with a repetitive activity requiring flexion-extension.
Even a knee contusion can cause symptoms.
The medial plica can also become thickened and potentially symptomatic in any knee pathology (traumatic,
inflammatory).
There is inflammation and fibrosis of the plica which impinges on the trochlear or femoral cartilage,
and generates a medial patellar pain,
usually above the joint line [6].
Physical findings are non specific : crepitus,
pseudo-locking or effusion.
A painful cord palpable is pathognomonic,
but this sign has a poor sensitivity.
Arthroscopy is the gold standard to confirm the diagnostic.
Sakakibara classified mediopatelar plica into four types (A,B,C and D).
Type C and D are considered symptomatic when the plica is trapped between the medial condyle and patella [7].
Treatment is first conservative,
with drugs and physical therapy.
If no success,
arthroscopic resection is performed [8][9].
Magnetic Resonance (MR) signs to predict a medial plica syndrome are non univocal in the literature.
The purpose of this study was to identify MR characteristics of the medial plica to lead to a non invasive diagnosis of a medial plica syndrome.