目的:本研究旨在报道一种罕见的膝关节内侧滑膜皱折解剖变异的放射学和临床表现及其对保守治疗和手术治疗的反应。
方法:本报告描述了一名29岁的男性患者,患有右膝疼痛,下楼梯或长时间坐着时加重。体格检查显示髌侧内侧局部压痛,当膝盖伸展时,这个区域有明显的点击,和腿筋紧绷。磁共振成像显示内侧皱褶重复,特征是髌下脂肪垫内侧部分的高强度信号,之后提出了内侧皱褶综合征的推定诊断。保守治疗失败后,患者接受了标准的膝关节镜检查,显示出上低轮廓和下高轮廓的内侧皱褶,髌下脂肪垫内侧部分肥大。用机械剃须刀切除plicae和脂肪垫,直到在全运动范围内观察到股骨滑车和脂肪垫之间没有接触。术后4周,症状完全缓解,患者在1年随访时被允许恢复完全活动,无复发.
结论:本研究提出了一种罕见的膝关节内侧滑膜皱折解剖变异,有症状且难以保守治疗。此病例报告可能有助于放射科医生和整形外科医生区分这种特殊的皱褶类型,并考虑其在患者管理期间对保守和手术治疗的反应。
OBJECTIVE: The current study aims to report the radiologic and clinical appearance of a rare anatomical variation of the knee medial synovial plica along with its response to conservative and surgical treatment.
METHODS: This report portrays a 29-year-old male patient with anteromedial gradual onset right knee pain, aggravated when descending stairs or prolonged sitting. Physical examination revealed medial parapatellar local tenderness, a palpable click in this area when the knee was extended, and hamstring tightness. Magnetic resonance imaging showed a duplicated medial plica, characterized by a high-intensity signal of the infrapatellar fat pad medial portion, after which a presumptive diagnosis of medial plica syndrome was proposed. After conservative treatment failure, the patient underwent standard knee arthroscopy that revealed a superior low profile and an inferior high profile medial plica, and hypertrophy of the medial portion of the infrapatellar fat pad. Both plicae and fat pad were resected with a mechanical shaver until no contact between the femoral trochlea and the fat pad was observed during full range of motion. At 4 weeks postoperatively, symptoms completely resolved, and the patient was allowed to return to full activity with no recurrences at 1 year follow-up.
CONCLUSIONS: The current study presented a rare anatomical variation of the knee medial synovial plica that was symptomatic and recalcitrant to conservative treatment. This
case report may be useful for radiologists and orthopaedic surgeons to differentiate this special plica type and consider its response to conservative and surgical treatment during patient management.