The Correlation between Patellar Plica and Degeneration of the Femoral Condyle among Military Personnel

Abstract

Objective. To determine if there is a correlation between patellar plica syndrome and presence of osteochondral defect among patients who underwent diagnostic arthroscopy.

Methodology. This is a single-center, retrospective cohort study involving patients who underwent diagnostic arthroscopy of the knee with or without primary ACL reconstruction, meniscectomy, and application of Hyalofast scaffold done between January 1, 2018, and December 31, 2020. A retrospective chart review was conducted. Inclusion criteria were: (1) patients aged 18 to 56 years who underwent diagnostic arthroscopy; (2) patients with nonspecific anterior and anteromedial knee pain; (3) patients who were diagnosed with degenerative osteoarthritis via physical exam/X-rays; and (4) patients who had complaints of persistent knee pain with no improvement despite conservative management. The exclusion criteria were: (1) patients who have history of significant knee trauma causing fracture of the tibio-femoral and patello-femoral joint; and (2) patients who were diagnosed with septic arthritis and post-traumatic arthritis. Patients’ demographic data, history, physical examination findings were gathered and tabulated.

Results. There were a total of 70 patients who underwent diagnostic arthroscopy from January 2018 to December 2020. The prevalence rate of patellar plica syndrome was 10%. There were no significant differences noted in terms of age, gender, comorbidities, BMI, and length of military service. None of the patients with patellar plica syndrome had sports-related injuries (n = 0, p = 0.007), and most of these patients did not have other knee pathology (n = 6, 86%, p<0.001). The most common type of patellar plica noted intraoperatively was mediopatellar plica (71%), followed by infrapatellar plica (29%). Anterior and/or anteromedial pain was the most common symptom of patellar plica syndrome (100%), followed by pain when kneeling (71%). There were significantly fewer patients presenting with clicking or catching with patellar plica syndrome (p = 0.003), and significantly more patients who had a positive mediopatellar test on physical examination (p = 0.023). An osteochondral defect was present in 86% of the cases with patellar plica as compared to 21% of patients without patellar plica (p = 0.001).

Conclusion. Patellar plica syndrome was present in 10% of military personnel who underwent diagnostic arthroscopy. The presence of osteochondral defects were correlated with patellar plica.