Technical Note: Arthroscopic Resection of Snapping, Interponating Annular Ligament of the Elbow

The indication for surgical treatment of lateral snapping elbow syndrome is recurrent joint blockage in combination with pain of the affected elbow joint. Different parts of the lateral synovial capsule sleeve complex, including the annular ligament itself, a hypertrophic synovial fold, or meniscus-like soft tissue interposition can lead to painful entrapment. Surgical treatment options can include an arthroscopic or open procedure. The aim of this technical note is to provide a step-by-step illustration of the authorsʼ preferred arthroscopic approach with a comprehensive review of literature on clinical outcome.

RESULTS OF TREATMENT OF PLICA SYNDROME OF THE KNEE

ABSTRACT Objective: The synovial fold is an intra-articular structure found in more than 50% of the knees, which can cause symptoms similar to meniscal injuries. These symptoms are mostly related to hypertrophy of the synovial fold resulting from inadequate physical activity. Conservative treatment with readjustment of sports activity and muscle rebalancing solves most cases. Rare cases require surgical treatment, which is indicated due to the persistence of instability, blockage and pain. We present our experience in the treatment of this pathology. Methods: 58 patients (70 knees), with 62 knees treated conservatively and 8 treated surgically exclusively for the pathological synovial fold. Results: Description of the series and treatment results are reported. Conclusion: The non-surgical treatment of the pathological synovial fold of the knee provided good results within 60 days of rehabilitation program in almost 90% of the patients. Arthroscopic resection of the synovial fold is a surgery that has a longer and laborious rehabilitation period, despite good results in most cases. Level of Evidence IV, Case series.

Influence of femur condylus dysplasia on development of mediopatellar synovial fold hypertrophy

Among all anatomic folds of the knee joint, mediopatellar synovial fold has the highest rate of pathological changes that also have influence on adjacent anatomical structures. Presence rate of mediopatellar fold is 4650% according to cadaveric data and 1880% according to data acquired in an arthroscopic way. In this work, we studied the possible link between femur condylus dysplasia and forming of the mediopatellar fold. The MRI study was done to 116 patients divided into two equal groups (58 patients in each). The main group (group I) included patients with detected femur condylus dysplasia, the control group (group II) patients without detected femur condylus dysplasia. Our results suggest that in the main group the mediopatellar fold is detected in 53 patients (91,4% of all cases), in the control group in 4 patients (6,9% of all cases). The results support our hypothesis that while performing the arthroscopic treatment of the patologically thickened mediopatellar synovial fold, the dysplasia of femur condylus must be taken into account.

Hypertrophic Syndesmotic Impingement and Its Effect on the Ankle Joint

Category: Ankle, Arthroscopy Introduction/Purpose: During ankle arthroscopic surgery, chronic syndesmotic instability is a common combined finding of ankle instability and induces the development of a hypertrophic synovial fold. This pathologic lesion protrudes into the ankle joint cavity in various tissue types, such and hypertrophied synovium, fat or fibrosis. However, the effect of this impingement tissue on the ankle joint and the associated clinical significance have not been well-evaluated. This study aimed to identify the histological type of the syndesmotic impingement tissue and analyze its effect on the lateral talar dome cartilage, in addition to the clinical correlation with the tissue type. Methods: A total of 62 patients (64 ankles) with chronic ankle instability and syndesmotic impingement who underwent arthroscopic surgical management from January 2017 to June 2018 were enrolled in this study. During arthroscopic surgery, we visually classified the hypertrophic syndesmotic tissue and performed biopsy. We also evaluated the prevalence of cartilage lesions at the lateral talar dome with its location. The association between the duration of symptoms and tissue diagnosis was also evaluated. Results: Based on the pathologic results, 4 samples with fat degeneration, 37 samples with fibrosis, 7 samples with synovial hypertrophy, 12 samples showing mixed type hypertrophy, and 4 samples with other type of hypertrophy were identified. Among the 64 cases, articular cartilage lesions at the lateral talar dome were present in 15 cases. In 10 of 15 cases, the pathologic results revealed the presence of fibrous tissue, while 5 cases of other type including synovial hypertrophy, were identified. In 13 cases, the cartilage lesions were located in the middle third of the lateral talar dome. The patients experienced ankle joint instability for 35.5 ± 33.7 months. Longer duration (>24 months) of instability was associated with a higher rate (81.8%) of fibrotic change in the syndesmosis. Conclusion: Repetitive syndesmotic impingement can cause hypertrophic synovial changes; the hypertrophic synovial tissue may evolve into fibrotic impingement tissue as the duration of symptom persistence increases. If the hypertrophic tissues are fibrotic, they may be harder in terms of physical properties and may cause the development of cartilage lesions at the talar dome due to the repetitive load. Considering our results, prophylactic debridement may be effective to prevent the development of cartilage lesions at the talar dome, when hypertrophic tissues are observed during arthroscopic surgeries.

Orthopedic Nursing Based on Preoperative Diagnosis of Infrapatellar Plica Using Medical Imaging

Purpose: We investigate the diagnostic value and therapeutic effect of arthroscopy on the knee synovial fold syndrome. Methods: Thirty patients (35 knees) who has knee subgingival fold syndrome were treated with knee arthroscopy and medial temporal synovectomy. All these patients in this group were treated with epidural anesthesia and underwent arthroscopic surgery. MRI was used initially to diagnosis the orthopedic conditions before surgical intervention. At the second observation, it can be seen that the inner wrinkle is hard and it has a white cord-like shape. Generally, the wrinkled wall is fan-shaped, while some of the wrinkled walls are continuous with the upper, lower and outer wrinkles. Changes were evaluated using the Lysholm score in knee function before and after surgery. Results: The treatment is demonstrated: the preoperative average Lysholm score (51.37 ± 6.36), the average Lysholm score (93.00 ± 5.04), and the average improvement of 42 points. The difference between the preoperative and postoperative functional scores was statistically significant (t = 15.283, P < 0.05). Discussion: There are many reports on the synovial wrinkle syndrome in the knee synovial fold syndrome, and the report of the subclinical fold syndrome is extremely rare, and it is considered to be only a manifestation of other syndromes. This aspect shows that the incidence of the knee synovial fold syndrome is relatively low, on the other hand, it also shows that the current understanding of the knee synovial fold syndrome is insufficient. The knee synovial fold syndrome lesions occur mostly in young men and young adults, and are associated with trauma and excessive use of injuries, but the knee synovial fold syndrome and signs are not specific, easily misdiagnosed, and need to be diagnosed under arthroscopy. Arthroscopic treatment of the knee synovial fold syndrome is simple and safe, with less damage and quick recovery after surgery. Conclusion: Arthroscopy has obvious diagnostic value and good therapeutic effect on the knee synovial fold syndrome.

Magnetic Resonance Imaging of Hoffa’s Fat Pad

Background. Pathological changes in the size and structure of Hoffa’s fat pad can cause pain in the anterior section of the knee joint. Therefore, they should be diagnosed. The objective of the paper is to improve the diagnostics of Hoffa’s fat pad disease on the basis of a detailed study of the clinical anatomy of the infrapatellar (Hoffa’s) fat pad and magnetic resonance imaging (MRI) findings in normal and pathological conditions.Materials and Methods. Protocols of 86 MRI examinations of knee joints with anterior knee pain syndrome and no clearly defined traumatic history nor positive clinical tests indicating damage to the intra-articular and periarticular elements with identified structural changes in the fat pad were selected retrospectively. The control group consisted of data from 24 examinations of asymptomatic knee joints. In all cases, the pathology was confirmed during diagnostic and therapeutic arthroscopy.Results. The MRI findings showed the normal structure of the infrapatellar fat pad, as well as pathological changes in the form of tearing, local edema, diffuse edema, synovial proliferation and fibrosis. Depending on the location and type of changes, 4 pathological syndromes were identified: “classic” Hoffa’s disease — 49 (57%) cases, infrapatellar synovial fold syndrome — 11 (13%), infrapatellar synovial fold separation syndrome — 6 (7%), and impingent syndrome of upper lateral adipose tissue — 20 (23%) cases.Conclusions. To identify a pathology, a precise synchronization of clinical and morphological changes is required. Accurate differentiation of syndromes is possible due to knowledge of the detailed anatomical and magnetic-resonance features of the fat pad in normal and pathological conditions. This allows to diagnose the cause of pain in the anterior sections of the knee joint, specify the diagnosis, and choose the optimal plan of treatment.