What Is Plica Syndrome?

(I) Causes of Onset

Squat pain in one leg

Squat pain in one leg is one of the main symptoms of cartilage injury of patellofemoral joint. Articular cartilage injuries are very common in sports injuries, but due to the difficulty of diagnosis, especially early diagnosis is almost impossible in routine examinations, it is often ignored and cannot be treated in time. However, no matter what kind of cartilage damage, it may eventually lead to degeneration and necrosis of chondrocytes and leave permanent damage.

Symptom name

Squat pain in one leg

Department

orthopedics

Department

Lower limb

(I) Causes of Onset

Any factor that affects the normal secretion of the synovial membrane or the squeezing mechanism of the articular cartilage and hinders the normal movement of the joint can cause damage to the articular cartilage.

(Two) pathogenesis

1. Acute or chronic trauma may directly impact cartilage, destroying the collagen fiber network arch structure in cartilage. It can also directly cause tangential fracture of cartilage. Chrisman has studied the relationship between trauma and sacral osteochondrosis from a biochemical perspective for many years. He found that the free arachidonic acid concentration in cartilage can be increased by 4 times within 2 hours after the cartilage is hit by the trauma. Arachidonic acid is the main component of the phospholipid membrane, the precursor of prostaglandin, and its product is transformed into prostaglandin E2, which stimulates the AMP cycle, releases tissue protein kinase, destroys the chain of chondroitin sulfate and protein in the cartilage matrix, and makes the cartilage matrix Lost, causing softening of cartilage. Metabolites enter the synovial fluid and cause synovial inflammation, which in turn stimulates the synovium to release a large amount of enzymes, further destroying cartilage and causing a vicious cycle.

2. The strain of patellofemoral joint causes abnormal friction and compression of patellar cartilage for a long time, especially repeated squatting, jumping, weight bearing and twisting in the knee flexion position can cause excessive stress between patellofemoral or The uneven distribution of stress makes the patella cartilage prone to damage and suffer from patella cartilage disease.

3. Patella femoral joint instability Common instability factors such as high or low metatarsal bones, abnormal knee Q angles, metatarsal tilt, tibial torsion deformity, abnormal metatarsal or femoral condylar development, due to abnormal metatarsal position or alignment misalignment, or cause The contact surface and contact stress between patellofemoral joints are abnormal and cause patella cartilage disease. Many scholars have done a lot of work on the stress distribution and stress testing of patellofemoral joints, including the theory of high contact pressure theory, low contact pressure theory, the theory of uneven pressure division, and the theory of increased pressure of the sacrum bone. They all have experimental support. However, no matter whether the pressure is too high, the pressure is insufficient, or the pressure is uneven, as long as the pressure exceeds or does not reach the range that the sacral cartilage can normally withstand, cartilage degeneration may be caused.

4. Pathological changes The main pathological changes of patella osteochondrosis are manifested by softening, yellowing, cracking, exfoliation, ulceration of patella cartilage, and increased synovial inflammation and secretion. Peri-fascial fasciitis and paracondylar support bands are inflammatory. Change and hyperplasia or contracture. The detached cartilage pieces may dissociate into articular rats in the joint cavity, causing interlocking of the knee joint.

Athlete's sacral cartilage lesions are most commonly seen on the medial side, followed by the central area (60 ° contact area) and medial area. However, Ficat reported the highest incidence in the lateral area.

Rijnds divides cartilage lesions of patella osteochondrosis into four degrees. The first degree was a slight fissure in the surface layer of cartilage, softness, mild swelling and yellowing of cartilage in the lesion area, which was roughly equivalent to the first layer (static layer) injury of chondrocytes. The second degree was the damage of the second layer (transition layer) and the third layer (mast cell layer) of cartilage, with shallow cracks visible to the naked eye. The third degree was the damage of the fourth layer (calcification layer) of cartilage, deepening of fissures, local access to subchondral bone, and cartilage fragments exfoliated from the surface layer. degree is the damage to the subchondral bone, ulcer formation, local cartilage destruction. There is often a gradual erosion of healthy cartilage around the lesion, and adjacent cartilage often has varying degrees of degeneration. ^[1]

1. The most common symptoms are post-condylar pain, which occurs in the active or semi-squat position. It is initially sore and uncomfortable, and then develops into persistent or progressive soreness. The pain is often noticeable at the beginning of the activity, reduced after the activity, and worsened at the end of the activity or at rest. This pain is sometimes characteristic and is often described as "caries-like soreness." Soreness when going up and down stairs, especially when going downstairs or downhill. Often there are complaints of soft knees and "almost fall". Sometimes there are joint lock symptoms.

One-leg half-squat pain 2. In terms of physical signs, the main characteristics are as follows:

At the time of physical examination, attention should be paid to the identification of synovial fold syndrome (Plica syndrome) and femoral condylar osteochondrosis of the knee joint. Clinical examinations are often performed after the pain point is closed, as a diagnosis of exclusion.

(A) treatment

1. Conservative Therapy Conservative therapy is the basic and main treatment method for this disease. The following measures are commonly used.

(1) Quadriceps exercise: It is the most commonly used and effective method for the prevention and treatment of sacral osteochondrosis. By strengthening the strength of the quadriceps, it can increase the stability of the joint, improve the stress distribution of the patellofemoral joint, and prevent falls or accidental injuries caused by sore knees and tenderness. Common methods, such as standing piles, generally use the standing piles against the wall to avoid pain angles. You can also do active straight leg lifting or weight straight leg lifting exercises. Combined with the results of isokinetic test, the Department of Sports Medicine of Shanghai Huashan Hospital selects several joint angles that do not cause pain, do multi-angle isometric quadriceps exercises, or do short-arc isokinetic exercises with no pain in the range. Quadriceps strength is better.

(2) Patella femoral joint adhesive support belt or protective gear: As an important means of conservative treatment, sports trauma doctors often recommend those patients who do not want surgery to use patella adhesive tape or patella protective gear to change the trajectory of Contact mechanics to achieve the purpose of pain relief and disease treatment.

(3) Massage and physical therapy: wax therapy and ultrashort wave have certain effects.

(4) External application of traditional Chinese medicine: safflower 30g, Shengchuanwu 30g, Guiwei 30g, licorice 30g, natural copper 30g, pomegranate 30g, Caowu 30g, ginger 9g, soak the wine for 7 days, take the juice and apply it locally Direct current is introduced with good effect.

(5) Intra-articular injection: Triamcinolone Acetate or Corning Ketong injection is used once a week. The short-term effect is good, and it can only be temporarily applied to athletes who need to participate in the competition. Recently, it has also been reported that sodium hyaluronate (sodium hyaluronate) is injected into the joint cavity once a week and 5 times as a course of treatment, which has a certain effect.

2. Surgical treatment is not effective for conservative treatment. In severe cases of patella sclerosis, surgical treatment can be considered. According to Cotta (1959), there are as many as 137 surgical methods, making the disease one of the most commonly treated orthopedic diseases.

(1) Limited cartilage resection and drilling: As the basic technique that is still commonly used at present, arthroscopy or anterolateral or anterolateral incision of the iliac crest can be used to remove degenerate cartilage with a planer and expose the subchondral bone plate. , Use a 1 ~ 2mm drill bit to drill several holes. The purpose of this operation is to make fibrous granulation tissue from the bone fill the defect cartilage, and finally transform into fibrocartilage. Drilling can also release internal bone pressure and relieve pain.

(2) Sacral rearrangement surgery: including proximal and distal rearrangement. Proximal rearrangement techniques such as lateral support band release (cut off the patellofemoral ligament, the oblique bundle under the metatarsal, and part of the lateral femoral tendon), medial quadriceps transposition (fixed to the middle of the dorsal side of the metatarsal) . Distal rearrangement mainly includes tibial tubercle elevation, or internal movement after elevation. Some recent studies have suggested that tibial tubercle elevation is most suitable for 1 to 1.5 cm. Chen Shiyi and other studies have confirmed that the mechanism of tibial tuberosity elevation to relieve patellofemoral pain is to change the habitual patellofemoral contact area and avoid the stimulation and compression of the original ulcer area. However, there is a certain range of the Q angle of the knee joint anatomically. When rearranging the distal or proximal patella, it is necessary to prevent the line of force from being overcorrected. If the Q angle is increased or decreased by more than 10 ° after surgery, a new The patellofemoral instability increases the damage of the patellar cartilage.

(3) Patella osteotomy: Arnoldi has been committed to the research of patella internal pressure for many years. He advocates using patella osteotomy to relieve intraosseous hypertension and relieve pain, while adjusting the patellofemoral joint surface to make it more coordinated.

(4) Artificial joint replacement: For patients with severe patellofemoral joint osteoarthritis, patellofemoral joint artificial surface prosthesis can be considered for treatment.

(5) Cartilage transplantation: including autologous chondrocyte transplantation and autologous osteochondral block honeycomb transplantation (also known as mosaic cartilage transplantation). The former takes the patient's autologous cartilage for in vitro chondrocyte culture, and uses tissue engineering methods to implant the cultured and proliferated chondrocytes into the lesion area, and then covers it with periosteum. More than 1,000 cases have been successfully reported worldwide. The autologous osteochondral block mosaic transplantation uses special equipment to excavate the osteochondral tissue of the knee joint femoral condyle non-load-bearing area. These columnar osteochondral blocks are transplanted into the load-bearing area cartilage and mosaic-like transplantation is performed. It is reported that the excellent rate can reach 80%. Both methods can be performed under arthroscope.

(6) Sacral resection: Only for severe patients with severe pain and affecting daily life. Knee extension strength was reduced by 30% after simple patella resection. After resection, the patellar tendon and the quadriceps were directly sutured, and the knee extension strength was reduced by 15%. At the same time, the diseased part of the tendon around the sacrum should be removed or thinned to close to the normal thickness, otherwise pain will still occur when the knee is stretched and flexed.

(B) the prognosis

Commonly used non-surgical treatments can alleviate or reduce symptoms and generally have a good prognosis.