Article
Predictors for an unsuccessful conservative treatment of patients with medial patellar plica syndrome
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Authors
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Fabian Blanke
- Universitätsmedizin Rostock, Orthopädische Klinik und Poliklinik, Schön-Klinik München-Harlaching, Rostock, Germany
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Nicola Oehler
- Hessing Stiftung Augsburg, Augsburg, Germany
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Wolf Christian Prall
- Schön-Klinik München-Harlaching, München, Germany
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Thomas Tischer
- Universitätsmedizin Rostock, Orthopädische Klinik und Poliklinik, Rostock, Germany
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Stephan Vogt
- Hessing Stiftung Augsburg, Augsburg, Germany
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Robert Lenz
- Universitätsmedizin Rostock, Orthopädische Klinik und Poliklinik, Rostock, Germany
| Published: | October 26, 2021 |
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Outline
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Objectives: In several cases persistent medial knee pain remains after conservative treatment in patients with medial patellar plica syndrome. In recent literature accepted criteria for surgical indication are lacking. In this retrospective study patients after conservative treatment were evaluated to identify predictors for an unsuccessful outcome.
Methods: 132 patients with medial patellar plica syndrome between 2016-2019 were retrospectively evaluated. All patients received conservative treatment for three months. Surgery was indicated due to failed conservative treatment (n=76) with persistent medial knee pain and restriction of activity after three months. Preoperative MRI analysis, Lysholm score, pain by the Visual Analog Scale (VAS), postoperative sports participation (RTS) and Tegner Activity Score were collected at least 12 months after definite treatment. Statistical analysis was performed to evaluate differences between patients with successful and unsuccessful conservative treatment.
Results and Conclusion: There were significant differences in the clinical and radiological findings between patients with successful and unsuccessful conservative treatment. Patients with failed conservative treatment showed a significant larger diameter of the medial patellar plica (0.8 ± 0.3 mm vs.1.6 ± 0.4 mm; p < 0.05) and a significant higher rate of contact of the plica to the adjacent cartilage. Furthermore, these patients reported a significant higher rate of medial knee pain from flexion to extension and snapping symptoms.
At final follow up the patient-reported outcome by means of Lysholm score (96.25 vs. 95.93), RTS (96.2% vs. 97%) and Tegner activity score (6.0 vs. 6.01) was excellent after conservative and surgical treatment. There were no statistical differences in the preoperative and postoperative outcomes between both.
The diameter of a medial patellar plica (>= 1.2 mm) and contact of the plica to the adjacent cartilage as well as clinical signs like persistent medial knee pain from flexion to extension with snapping symptoms can predict an unsuccessful conservative treatment and the need for surgical intervention in patients with painful medial patellar plica syndrome.
