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Randomized Controlled Trial
. 2013 Oct 12:14:292.
doi: 10.1186/1471-2474-14-292.

Prevalence of MRI-detected mediopatellar plica in subjects with knee pain and the association with MRI-detected patellofemoral cartilage damage and bone marrow lesions: data from the Joints On Glucosamine study

Daichi Hayashi  1 , Li Xu, Ali Guermazi, C Kent Kwoh, Michael J Hannon, Mohamed Jarraya, Stephanie M Green, John M Jakicic, Carolyn E Moore, Frank W Roemer
Affiliations
Randomized Controlled Trial

Prevalence of MRI-detected mediopatellar plica in subjects with knee pain and the association with MRI-detected patellofemoral cartilage damage and bone marrow lesions: data from the Joints On Glucosamine study

Daichi Hayashi et al. BMC Musculoskelet Disord. .

Abstract

Background: The mediopatellar plica is a synovial fold representing an embryonic remnant from the developmental process of the synovial cavity formation in the knee. We aimed to examine the frequency of MRI-detected mediopatellar plica and its cross-sectional association with MRI-detected cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ) in a cohort of subjects with knee pain.

Methods: 342 knees with chronic frequent knee pain were evaluated for MRI-detected mediopatellar plica (type A, B or C according to the modified Sakakibara classification). Cartilage damage (scored 0 to 6) and BMLs (scored 0 to 3) were semiquantitatively assessed in four subregions of the PFJ on MRI. Hoffa-synovitis and effusion-synovitis were graded 0 to 3. Patellar length ratio (PLR), lateral patellar tilt angle (LPTA), bisect offset (BO), and sulcus angle (SA) were measured on MRI. The presence of mediopatellar plica and its association with cartilage damage and BMLs in the PFJ was assessed using logistic regression after adjusting for age, gender, body mass index, PLR, LPTA, BO, SA, and Hoffa- and effusion-synovitis.

Results: 163 (47.7%) knees exhibited mediopatellar plica (76 (22.2%) type A, 69 (20.2%) type B, and 18 (5.3%) type C) on MRI. Significant cross-sectional associations of MRI-detected mediopatellar plica and cartilage damage were observed for the medial patella (adjusted odds ratio (aOR) 2.12, 95% CI 1.23-3.64 for all types combined, and aOR 4.20, 95% CI 1.92-9.19 for type B lesion), but not for the anterior medial femur or the lateral PFJ. No associations were found between the presence of MRI-detected mediopatellar plica and BMLs in any patellofemoral subregion.

Conclusion: On MRI, types A and B mediopatellar plicae were commonly observed in this cohort of subjects with knee pain. MRI-detected mediopatellar plica was cross-sectionally associated with higher likelihood of the presence of MRI-detected medial patellar cartilage damage after adjustment for confounders.

Trial registration: ClinicalTrials.gov NCT00277286.

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Figures

Figure 1
Figure 1
MRI classification scheme of mediopatellar plicae modified from the Sakakibara arthroscopic classification. (A) Type A lesion in the left knee consisting of a cord-like elevation in the synovial wall; (B) Type B lesion in the left knee, which has a shelf-like appearance but does not cover the anterior surface of the medial trochlea; (C) Type C lesion in the left knee, which has a large shelf-like appearance and covers the anterior surface of the medial trochlea.
Figure 2
Figure 2
Schema of measured patellar alignment indices. (A) The sagittal slice referring to the middle of medial patellar facet: patellar length (PL, white broken line), patellar tendon length (TL, black line) and patellar length ratio (PLR = PL/TL) were measured; (B) On the axial slice at the level of superior 1/3 of trochlea, sulcus angle (SA) was measured; (C) and (D) On the specific axial slice that was defined by the bisecting line between the superior and inferior osseous patellar pole, lateral patellar tilt angle (LPTA) and bisect offset (BO = a*100/(a + b)) were measured.
Figure 3
Figure 3
Type C mediopatellar plica with cartilage damage and BMLs in the medial patella. (A) Axial dual echo steady-state (DESS) image shows a type C mediopatellar plica (white arrow). (B) Sagittal intermediate-weighted fat-suppressed (IW FS) image shows a WORMS grade 2.5 full thickness focal defect (white arrow) and a corresponding WORMS grade 1 BML in the medial patella (grey arrow).
Figure 4
Figure 4
Type A mediopatellar plica with a bone marrow lesion (BML) in the anterior medial femur. (A) Axial dual echo steady-state (DESS) image shows a type A mediopatellar plica (white arrow). (B) Sagittal intermediate-weighted fat-suppressed (IW FS) image shows a WORMS grade 1 BML in the anterior medial femur (grey arrow head), a finding that was not associated with mediopatellar plica.
See this image and copyright information in PMC

References

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