The thesis provides the basic principles of diagnosis and treatment of medial
patellar plicasyndrome (MPPS) of a knee joint (KJ) by studying the diagnostic value
of clinical and instrumental tests, the development of differentiated tactics of
arthroscopic treatment.
It was found that medial collateral ligament injury (23.3%, p=0.002) and
gonarthrosis (18.3%, p=0.024) false diagnosis are the reasons of delayed treatment at MPPS; the left-side syndrome (65.8%) is found more often than right-side (34.2%).
The indirect mechanism (72.3%) with extension (32.2%), flexion (15.8%) or rotation
(24.3%) are the crucial in MPPS. The gender features are characterised with delayed
diagnostics in male vs. female as 80.5 vs. 43.4% (p<0,001); in the age 20.0-35.0
MPPS is verified in men (72.8%, p<0,001) more often, however, in 36-50 age group -
in women (p<0.001). According to SF-36 scale, the indicators of patients with MPPS
were below average in terms of both physical and emotional functioning (p <0.05),
but higher level of life quality in male with MPPS is found, same in terms of physical
(p<0.05) and mental health (p<0.05).
Diagnostic value has been proven for medial and ventro-medial pain
syndromes with 94.9% sensitivity and 56.6% specificity, “stepwise” syndrome –
92.9% sensitivity and 43.4% specificity, flexion pain – 86.7 and 58.6%, extension
pain –72.7 and 87.9%, clinical (90.9% sensitivity, 96.9% specificity) and mechanical
(74.8% sensitivity, 96.9% specificity) blocks, and also medial patellar plica test with
97.9% sensitivity and 98.9% specificity.
Non-specific changes in MPPS were proved, such as significant reduction in
amplitude during goniometry (p <0.05); decreasing of forced capabilities in flexor
during all regimes of dynamometry (p<0.05); the reliable asymmetry in stabiography
test (p<0.05). MPPS is characterised by the higher para-articular tissue resistance
(p<0.05), decreased in systolic (p<0.05) and diastolic wave amplitudes (p<0.05), and
also systolic and diastolic rheographic indexes (p<0.05) during rheovasography.
During radiography the direct signs of MPPS were not detected, but medial femoral
comb on was verified in some cases.
Morphological types A (8.8%), B (16.5%), C (49.5%), D (25.2%), and clinical
stages I (8.5%), II (59.9%), III (31.6%) are reliably verified during magnetic
resonance imaging (MRI) with high sensitivity (88.2%), specificity (97,1%),
prognostic positive (96.7%) and negative value (89.2%). According to the own
proposed method for MPPS verifying, high sensitivity (100.0%), specificity (99.0%),
reliable prognostic value (99.0%), and likelihood ratio for a positive test (100.0%)
during MRI vs. arthroscopy were proved.
Sensitivity of arthrosonography in the patients with MPPS was set as
72.0% (62.5-79,8.0, specificity – 77.9% (68.0-85.4). The upper recess effusion with
100.0% sensitivity, synovial hypertrophy (80.0%), villies (27.0%), plica sclerosing
(67.0%), patella displacement (32.0%), chondromalation (57,0%) were indirect signs
of MPPS during sonography.
A significant reduction in pain syndrome with the additional usage of
vaporization (p1<0.05), NSAIDs dosages reduction in 53.0% (debridement) and
77.0% (debridement with vaporization) were found. Higher clinical efficiency
(p<0,05), higher life quality (p<0,05), IKDC functional status (p<0,05) and Lisholm
scale (p<0,05) were shown in patients which were treated with combined
debridement and vaporization.
The usage of arthroscopic treatment for MPPS reliably improved the indexes of
dynamometry (p<0.05) and rheography. It was shown that the incidence of
postoperative hemarthrosis was 10.0% (debridement) vs. 0.0% (vaporization,
p<0.05), synovitis – 17.5% vs. 6.7% (p=0.09).
