Anatomy and MR Imaging Appearances of Synovial Plicae of the Knee

Roberto García-Valtuille, MD ; Faustino Abascal, MD ; Luis Cerezal, MD ; Ana García-Valtuille, MD ; Teresa Pereda, MD ; Ana Canga, MD ; Antonio Cruz, MD

1 From the Departments of Radiology (R.G.V., F.A., L.C., T.P., A. Canga) and Pathology (A.G.V.), Instituto Radiológico Cántabro, Clínica Mompía, Avda de los Condes s/n, 39108 Santa Cruz de Bezana, Cantabria, Spain; and the Department of Traumatology, Mutua Montañesa, Santander, Cantabria, Spain (A. Cruz). Presented as an education exhibit at the 2000 RSNA scientific assembly. Received May 2, 2001; revision requested June 4 and final revision received March 5, 2002; accepted March 13.

Synovial plicae are normal anatomic structures of the knee that sometimes become symptomatic. Magnetic resonance (MR) imaging and MR arthrography are useful tools in the evaluation of synovial plicae and allow differentiation of these entities from other causes of knee pain. At MR imaging, synovial plicae appear as bands of low signal intensity within the high-signal-intensity joint fluid. Gradient-echo T2-weighted and fat-suppressed T2-weighted or proton density–weighted MR images are optimal for the evaluation of plicae. Plica syndrome, the painful impairment of knee function in which the only finding that helps explain the symptoms is the presence of a thickened and fibrotic plica, should be included in the differential diagnosis of internal derangement of the knee. A diffusely thickened synovial plica, perhaps associated with synovitis or erosion of the articular cartilage of the patella or femoral condyle, in a patient with no other significant MR imaging findings suggests the diagnosis of plica syndrome. Once the diagnosis has been made, nonsurgical treatment is preferable initially. Failure of the patient to improve with conservative treatment leaves arthroscopic excision of the pathologic plica as the treatment of choice.