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Pathological mediopatellar plica found in the knee of an infant
1Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Insights
A rare case of pathological mediopatellar plica in a 15-month-old infant caused significant knee flexion contracture. Arthroscopic resection improved knee extension, highlighting this condition
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pediatric Rheumatology
Background:
- A 15-month-old infant presented with a 40-degree knee flexion contracture.
- Mediopatellar plica syndrome is typically seen in adults, making this pediatric case unusual.
Observation:
- Arthroscopic examination revealed a large, thick mediopatellar plica obstructing knee extension.
- A unique longitudinal groove on the medial femoral condyle accommodated the plica during flexion.
Findings:
- Arthroscopic resection of the pathological mediopatellar plica resulted in a 10-degree improvement in knee extension.
- Histological examination showed synovial hypertrophy and chronic inflammation.
- Post-operative physical therapy, including range-of-motion and quadriceps exercises, was crucial for recovery.
Implications:
- This case demonstrates that pathological mediopatellar plica can occur in infants.
- Early diagnosis and intervention are essential for managing pediatric knee contractures.
- Further research is needed to understand the etiology and prevalence of this condition in young children.
Abstract:
We report the case of a pathological mediopatellar plica found in the right knee of a 15-month-old infant girl. Flexion contracture of the knee was found to be 40 degrees. An arthroscopic view showed a large and thick voluminous mediopatellar plica. It was trapped between the patella and the medial femoral condyle and it was in tight contact with the medial facet of the patella at 40 degrees flexion in the knee, blocking further extension. A longitudinal groove was noted on the articular surface of the medial femoral condyle that looked as if it had another trochlea on arthroscopic view. The mediopatellar plica came into contact with the groove at 60 degrees flexion in the knee and it fitted precisely into the groove at further flexion. The pathological plica was resected arthroscopically, which resulted in approximately 10 degrees improvement in extension of the knee. Histological examination found hypertrophy and chronic nonspecific inflammation of the synovium. The patient was helped with range-of-motion exercise and quadriceps-strengthening exercise. At 27 months follow-up, the knee had gained full extension. This article reports that a pathological mediopatellar plica may develop in infants.