If conservative treatment fails, consider surgical repair
Conservative treatment—a combination of analgesics, anti-inflammatories, and physiotherapy with vastus medialis strengthening and stretching—is the preferred first-line treatment, with a success rate of 40% to 60%.1 If conservative treatment fails, surgical treatment can be considered; this entails complete resection of the plica, which has a success rate of 60% to 80%.6 If the symptomatic plica is left untreated, cartilage erosion (visible on MRI and/or arthroscopy) may occur as a result of the patellar facet and the condyle rubbing together when the knee is flexed at an angle of 30° to 60°.7
Our patient underwent arthroscopic resection of the plica after 6 months of conservative treatment had failed (FIGURE 2). The patient was able to walk immediately after surgery. The outcome was favorable, since physiotherapy was no longer required 2 months after surgery.
IMAGE COURTESY OF CÉLINE KLEIN, MD
CORRESPONDENCE
Céline Klein, MD, Service d’Orthopédie Pédiatrique, CHU Amiens, Groupe Hospitalier Sud, F-80054 Amiens cedex 1, France; celinekleinfr@yahoo.fr.