Sunday 3 October 2021

Medial patellar plica syndrome

Clinically young patient presented with anteromedial knee pain.

MRI sagittal T2 and axial T2 images delineates a linear well-defined low signal intensity band running across medial patellofemoral recess. However, there is no obvious associated bone marrow oedema involving medial articulating facet of patella or medial femoral trochlea. Mild associated joint effusion.
Medial plica mentioned in the report with joint effusion.

Medial plica syndrome

Synonym: synovial plicae of the knee.

The another common cause of anterior knee pain typically present with pain on anteromedial aspect of the knee, just cranial to the joint line with or without associated with crepitation, catching and locking sensations. Typically involves young with athletic background. 

There are actually synovial invaginations as a part of remnants of embryological development. They are encountered in MRI over 70% of individuals and are mostly asymptomatic. However these tags can get inflamed secondary to repetitive friction and stretching, making patient symptomatic. They can undergo fibrosis after long standing inflammation imparting them non-stretchable restricting the joint movement and painful.
In symptomatic patients, medial plica seen as low signal intensity band on T1 as well as T2-weighted images with an associated chondral defect involving medial articulating facet of patella.
Treatment is mainly conservative, physiotherapy and intra articular steroid injections.

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