**6.2 Plica excision**

268 Modern Arthroscopy

Using an electrothermal probe, adhesions are lysed and scarring is released to re-establish the suprapatellar pouch. Adhesions between the capsule and the femoral condyles are often observed and require release. The anterior interval is then re-established as necessary. 1 The medial and lateral patellar retinaculum are partially released if they are scarred, which improves patellofemoral mobility and capsular compliance. The intercondylar notch is then

After completing all anterior releases, the knee is then taken through a range of motion. If a persistent extension deficit remains, then the posterior compartment is assessed and

Postoperatively, an indwelling epidural catheter can help provide adequate pain management, which allows for immediate intensive physical therapy. Patients are placed in a continuous passive motion (CPM) machine immediately, and patellar mobilization and

Numerous authors have reported significant improvements of range of motion after lysis of adhesions from 35o to 68o. 32,33,34,35 The most common adverse outcome of this procedure is the inability to restore complete range of motion. 32,33,35 Several authors have also noted marked post-operative tenderness in the region of the infrapatellar fat pad, which resolved with non-operative measures. 32,33 Hematoma is rare with modern techniques using

Plicae are remnants of synovial membranes, which divide the embryologic knee into compartments. Plicae are traditionally described based on their anatomic location as suprapatellar, infrapatellar, and medial patellar or medial shelf. Lateral plicae have also

The suprapatellar plica is seen as a complete or partial synovial membrane that lies proximal to the proximal pole of the patella in the suprapatellar pouch. Arthroscopic studies have described an incidence of some form of suprapatellar plica as high as 87%. 36 The infrapatellar plica originates in the intercondylar notch and inserts into the synovium around the infrapatellar fat pad. Posteriorly, it may be separate from the ACL or attached to it. It is commonly seen during arthroscopy, with an incidence up to 86%. 36 The medial patellar plica originates on the medial wall of the knee, passes obliquely and inferiorly, sometimes crossing the suprapatellar plica, and inserts into the synovium surrounding the

The presence of a plicae does not necessarily indicate a pathologic condition. However, plicae may become symptomatic if thickened, hypertrophic, inflamed and/or fibrotic. 37 The medial plica is most commonly pathologic, resulting in snapping or abrasion against the

Pathologic plicae are notoriously difficult to diagnose because of their relative rarity, and shared symptoms with other more common knee pathology. There is often a history of trauma or repetitive stress, which may convert a non-pathologic plica into a symptomatic one. Patients mostly complain of pain in the location of the plica, which is usually exacerbated by activity, specifically kneeling or crouching. The incidence of swelling,

radiofrequency ablation and meticulous hemostasis during the procedure.

infrapatellar fat pad. The true incidence of the medial plica is unknown.

assessed for cyclops lesions.

**5.3 Results** 

**6. Plica excision** 

femoral condyle.

released as previously described.

range of motion exercises are emphasized.

**6.1 History and physical examination** 

been described, but are uncommon.

A standard diagnostic arthroscopy is always performed to ensure that other more common intra-articular pathologies are not present as the source of pain. Normal plicae appear soft and may be almost translucent at its edge and can be moved freely. In contrast, pathologic plicae often appear thickened and hypertrophic, while having the feel of a tight bowstring. Underlying chondral degeneration of the medial femoral condyle is often present with medial plica impingement.

When the diagnosis of a symptomatic plica is made, it should be resected along its entire length using an electrothermal probe. Care is taken to ensure that only the plica is resected, while protecting the surrounding structures.

The normal suprapatellar pouch extends to approximately 3-4cm proximal of the proximal pole of the patella. With the arthroscope in the suprapatellar pouch, failure to visualize the quadriceps tendon suggests the presence of a complete suprapatellar plica dividing the suprapatellar pouch. The presence of an incomplete or complete suprapatellar plica can result in a decrease of knee volume, and pain. 29 Thus, suprapatellar plicae can be resected in patients with parapatellar pain with an electrothermal probe.
