Arthroscopic Cartilage Regeneration Facilitating Procedure: A Decompressing Arthroplasty for Knee Osteoarthritis

Background The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been subject to debate. This study presents an innovative concept of arthroscopic management for knee OA and investigates its clinical outcome.Methods An arthroscopic cartilage regeneration facilitating procedure (ACRFP) to eliminate medial abrasion phenomenon and decompress the patello-femoral joints was performed on 693 knees of 411 patients with knee OA, mean age 60 years (34-90). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. Roentgenographic changes for all cases and magnetic resonance imaging (MRI) variations for twenty randomly selected cases were evaluated for objective outcomes. Results There were 634 knees in 369 patients (93.7%) available with more than 3 years of follow-ups (mean 40 months, SD 9). The overall subjective satisfactory rate was 91.1%. The KSS and all subscales of the KOOS improved statistically. Reversal of the degeneration process of cartilage was observed in 80.1% of the whole series (radiographic outcome) and in 72.2% of the 18 randomly selected cases (one-year MRI outcome study). Gender and OA severity were related to subjective outcomes. Age, body mass index (BMI), pre-operative hyaluronic acid injection, OA severity, and the type and severity of the medial plica are important predictors of radiographic outcomes. An analysis of failed cases reaffirmed the need for early ACRFP and skillful post-operative care. Conclusion ACRFP is an effective treatment for knee OA. If performed in time, it can satisfy most patients and might modify their degeneration process.

Arthroscopic Cartilage Regeneration Facilitating Procedure: A Decompressing Arthroplasty for Knee Osteoarthritis

Background The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been subject to debate. This study presents an innovative concept of arthroscopic management for knee OA and investigates its clinical outcome.Methods An arthroscopic cartilage regeneration facilitating procedure (ACRFP) to eliminate medial abrasion phenomenon and decompress the patello-femoral joints was performed on 693 knees of 411 patients with knee OA, mean age 60 years (34-90). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. Roentgenographic changes for all cases and magnetic resonance imaging (MRI) variations for twenty randomly selected cases were evaluated for objective outcomes. Results There were 634 knees in 369 patients (93.7%) available with more than 3 years of follow-ups (mean 40 months, SD 9). The overall subjective satisfactory rate was 91.1%. The KSS and all subscales of the KOOS improved statistically. Reversal of the degeneration process of cartilage was observed in 80.1% of the whole series (radiographic outcome) and in 72.2% of the 18 randomly selected cases (one-year MRI outcome study). Gender and OA severity were related to subjective outcomes. Age, body mass index (BMI), pre-operative hyaluronic acid injection, OA severity, and the type and severity of the medial plica are important predictors of radiographic outcomes. An analysis of failed cases reaffirmed the need for early ACRFP and skillful post-operative care. Conclusion ACRFP is an effective treatment for knee OA. If performed in time, it can satisfy most patients and might modify their degeneration process.

Plica syndrome after medial patellofemoral ligament reconstruction: a case report

A 16-year-old female with a history of left recurrent patellar dislocation underwent medial patellofemoral ligament (MPFL) reconstruction surgery. Two months postoperatively, the patient presented with medial patellar pain. Left medial plica syndrome was suspected, and we performed a partial arthroscopic resection of the medial synovial plica. The symptom gradually improved after surgery. To the best of our knowledge, there are no reports that discuss the relationship between postoperative pain of MPFL reconstruction and synovial plica as found in this case report. Surgeons should be aware of the possibility that asymptomatic synovial plica could become symptomatic.

A 10-Year Follow-up on Arthroscopic Medial Plica Syndrome Treatments with Special Reference to Related Cartilage Injuries

Objective The aim of this study was to evaluate the factors that can affect long-term results of arthroscopic resection of medial synovial plica of the knee. Design A total of 52 knees in 50 consecutive patients with medial plica syndrome (MPS) were enrolled to prospective study. Preoperatively the age, gender, level of activity, symptoms’ duration, Lysholm knee scoring scale (LKSS), Q angle, range of motion (ROM), and quadriceps output torque (QOT) were recorded. The plica was then arthroscopically excised while plica morphological type and cartilage lesions (International Cartilage Repair Society [ICRS] classification) were registered. The postoperative evaluation was done after 1 month, 3 months, 6 months, 3 years, and 10 years. The final assessment after 10 years covered LKSS, ROM, QOT, and was enriched with functional tests: the single leg squat test (SLS), the modified Ober test (MO), and the manual palpation of the vastus medialis obliquus (VMO). Results The mean LKSS increased from 52 (15-85, SD 16.479) preoperative to 80 (48-100, SD 15.711) at final follow-up examination. A significant negative correlation was found between LKSS and the patients’ age. Cartilage lesions higher than ICRS 1 significantly decreased the final LKSS. Results were significantly better in the subgroups with normal outcome of functional tests. Conclusions Clinical results of arthroscopic plica resection are better in patients without coexisting cartilage lesions. Poor neuromuscular control may contribute to abnormal patella tracking, leading to both medial plica irritation and further cartilage deterioration.

The incidence of medial plica in the knees operated on because of reasons other than the medial plica alone and the cartilage damages caused by it

Introduction: The aim of this study is to analyse the incidence of medial plica (MP) and the damage which has been caused on the medial femoral condyle in the 700 knee of 651 patients who were operated on because of the complaints resulting from intra-articular pathologies unrelated to the MP in particular. Patients and Methods: Medial plicas were detected in the 65 of 700 knees operated on consecutively because of the complaint of pain or catching in the knee. The mean age of 34 male and 28 female patients was 46 (range; 16-82). In 25 knees the lesions were in the right, 34 patients in the left side and in three patients, bilateral. The MP was classified according to the Sakakibara classification, the lesion caused by the MP on the medial femoral condyle, according to the Outerbridge classification. All medial plicas were excised arthroscopically. Results: Medial plicas were classified as type B in eight knees, type C in 52 and type D in five according to the Sakakibara classification. The cartilage lesion related to the MP were classified as type I in 12 knees, type II in 20 and type III in 24 according to the Outerbridge classification. There were no lesions present in nine knees. Discussion and Conclusion: Although the incidence of MP is much higher, the incidence of “MP syndrome” has been reported as 3.8% to 5.5% in the English literature. In the present study, we found that the incidence of MP was 9.28% associated with the rate of 86% type I-III cartilage damage related to the MP itself. Although the symptoms of MP are not specific, there may be some tenderness between the medial condyle and inferior-medial edge of patella. Furthermore a thickened cord-like plica can be palpated at the medial side of the patella, with crepitus or popping sensation during flexion –extension movement of the knee. If the patients suffer from meniscus tear or chondromalasia which affects at least two compartments of the knee, the symptoms of MP cannot be apparent primarily. These findings show that MP is quite significantly associated with other intra-articular pathologies in the knee. However, the common symptoms of MP with the long lasting pathologies in the knee (i.e chondromalasia unrelated to MP) can prevent early diagnosis which would prevent irreversible chondral pathologies developing at a later stage.