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Arthroscopic validation of the clinical exam for the detection of the symptomatic synovial-plical complex by relief from surgical excision.

PURPOSE
The goal is to introduce a reproducible exam technique that allows clinical diagnosis of symptomatic plical bands and associated synovium about the knee. We then aimed to assess the accuracy of the exam technique through arthroscopic confirmation of these tissues. Lastly, we hope to determine whether arthroscopic plicectomy and partial synovectomy is an effective treatment for alleviating the pain associated with symptomatic plica.


METHODS
This retrospective study evaluated 80 consecutive symptomatic knees under the care of a single physician diagnosed with symptomatic plica and associated painful synovium from 2001-2011. These patients underwent diagnostic and therapeutic arthroscopy to verify the presence of a plica and painful synovium with plicectomy and partial synovectomy if necessary. Statistical analysis was performed to determine the sensitivity and positive predictive value of the exam.


RESULTS
The medial parapatellar region was the most common location for symptomatic plica and associated synovial tissue. The exam technique described in this study had a sensitivity of 83.8% with a positive predictive value of 98.6% in the specific patient population described.


CONCLUSIONS
This study suggests that while the medial plical band is the most common, there is frequently sensitive synovial tissue found in multiple locations about the knee. This study also suggests that a thorough exam technique can accurately diagnose both the plical bands as well as the sensitive synovial tissue.


LEVEL OF EVIDENCE
Level II, Diagnostic Study. See the Guidelines for Authors for a complete description of levels of evidence.