Predictors for an unsuccessful conservative treatment of patients with medial patellar plica syndrome
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ARTHROSCOPY AND SPORTS MEDICINE
Predictors for an unsuccessful conservative treatment of patients with medial patellar plica syndrome Fabian Blanke1,2 · Nicola Oehler1 · Hasan Al Aidarous1 · Thomas Tischer2 · Stephan Vogt1 · Robert Lenz2 Received: 7 May 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction In several cases persistent medial knee pain remains after conservative treatment in patients with medial patellar plica syndrome. In recent literature accepted criteria for surgical indication are lacking. In this retrospective study patients after conservative treatment were evaluated to identify predictors for an unsuccessful outcome. Materials and methods 117 Patients with medial patellar plica syndrome between 2016 and 2019 were retrospectively evaluated. All patients received conservative treatment for three months. Surgery was indicated due to failed conservative treatment (n = 76) with persistent medial knee pain and restriction of activity after 3 months. Preoperative MRI analysis, Lysholm score, pain by the visual analog scale (VAS), postoperative sports participation (RTS) and Tegner activity score were collected at least 12 months after definite treatment. Statistical analysis was performed to evaluate differences between patients with successful and unsuccessful conservative treatment. Results There were significant differences in the clinical and radiological findings between patients with successful and unsuccessful conservative treatment. Patients with failed conservative treatment showed a significant larger diameter of the medial patellar plica (0.8 ± 0.3 mm vs. 1.6 ± 0.4 mm; p 6 weeks) over the palpable medial patellar plica in extension, which markedly diminished at 90° flexion (MPP test), with a verified medial patellar plica in the clinical examination and MR imaging [7, 16]. All patients were initially treated conservative for at least 3 months at different institutions. Conservative treatment included activity modification, sports restriction, physiotherapy with range of motion exercises, physical applications (cryotherapy, electronic stimulation) and NSAIDs. Surgery was only indicated after failed conservative treatment with persistent medial knee pain and restriction of activity after 3 months. Clinical and radiological findings of patients with successful and failed conservative treatment were compared. Further on the difference in the outcome scores after successful conservative treatment and operative treatment were evaluated. Exclusion criteria included any concomitant knee pathologies as meniscal or ligament lesions, chondropathies, synovitis, trochlea dysplasia, patellar maltracking (TTTG > 20 mm), leg axis deviation (> 3° varus/valgus) in the clinical or radiological examination, prior knee surgery, systemic diseases and BMI > 30. 132 patients with MPP syndrome were identified. 10 patients were unavailable for follow up and 5 patients did not consent to complete the survey and were therefore excluded for questio
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