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Dra. Sofía González
2023-04-26 |
Synovial plicae are embryologic remnants of the synovial lining of the knee, are frequently asymptomatic, but can become diseased with trauma and overuse.
Plica syndrome is a pathologic process due to inflammation of synovial plicae.
EMBRIOLOGY - FORMATION OF PLICAE
The mechanism of their existence is controversial. They are two main theories that explained their development.
The first and more widely accepted theory proposes the knee joint to form three separate compartments during development. They are separated by mesenchymal tissue into medial, lateral, and suprapatellar compartments. This tissue fuses during the 11th or 12th week of development and resorbs during the 16th week of development. As the membranes resorb, the three compartments coalesce to form one confluent joint cavity. If these membranes fail to resorb completely, they remain as synovial plicae.
The second theory advocates that during the eighth week of development the space between the distal femur and proximal tibial epiphysis becomes filled with mesenchymal tissue. Thereafter, specific territories of this tissue will either condense to form solid structures, such as ligaments and the menisci, or the tissue will resorb to form the meniscotibial, femoromeniscal, patellofemoral cavitations.
By the 10th week of development, these cavitations fuse to form a confluent joint cavity with a synovial lining. If cavitation is incomplete, or mesenchymal tissue fails to resorb completely, synovial plicae will form.
The variable morphology of plicae can present as suprapatellar, infrapatellar, lateral and mediopatellar, with the latter most commonly progressing to plicae syndrome.
DIAGNOSIS
Synovial plicae remain an interesting challenge to clinicians, as plica syndrome is a common condition with a wide differential diagnosis.
Many physical examination techniques can be used in conjunction with a thorough history to elucidate the presence of plica syndrome.
The diagnosis is made by exclusion, therefore a multitude of imaging modalities are necessary to rule out other causes of knee pain.
TREATMENT
Conservative treatment is recommended initially, however, its
effectiveness is variable.
Surgical intervention is a robust method for treating plica syndrome when conservative treatment fails.
Source: Hoehmann, Christopher. (2017). Plica Syndrome and its Embryological Origins. Edorium Journal of Orthopedics. 3. 1-12. 10.5348/O03-2017-5-RA-1.
