Ieda Yoshiki, Kotani Akihiro, Ishii Yoshiaki
Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka 181-8611, Japan.
J Orthop Sci. 2003;8(2):218-21. doi: 10.1007/s007760300036.
The plica synovialis mediopatellaris, a so-called shelf, is found in 20%-50% of normal knees. A shelf syndrome with pain or functional injury is uncommon, however, and cases that occur during the adolescent growth phase are rare. We report a rare case of a bilateral shelf syndrome that developed simultaneously in both knees. The patient was a 13-year-old girl who presented with bilateral knee pain and severely decreased range of motion. The symptoms were not alleviated after internal therapy, so arthroscopy was performed. It showed a white hypertrophied synovialis mediopatellaris, a shelf from the suprapatellar pouch, in both knees. The shelf had an opening between the free margin and the insertion point, giving rise to a synovialis mediopatellaris with a detached structure (type D according to the Sakakibara classification). The cause of the pain was thought to be impingement of the synovialis mediopatellaris. The shelf was ablated by arthroscopy using a holmium-YAG laser. Since the patient was a 13-year-old girl in the growth phase, it is possible that the growth resulted in tension on the shelf remnant bilaterally, intruding into the medial aspect of the patellofemoral joint and increasing the tension, resulting in the symptoms reported.
髌内侧滑膜皱襞，即所谓的“滑膜皱襞综合征”，在20% - 50%的正常膝关节中可见。然而，伴有疼痛或功能损伤的滑膜皱襞综合征并不常见，在青少年生长阶段发生的病例则更为罕见。我们报告一例罕见的双侧滑膜皱襞综合征，双侧膝关节同时发病。患者为一名13岁女孩，双侧膝关节疼痛，活动范围严重受限。内科治疗后症状未缓解，遂行关节镜检查。结果显示双侧膝关节均有白色肥厚的髌内侧滑膜皱襞，即来自髌上囊的滑膜皱襞。滑膜皱襞在游离缘与附着点之间有一开口，形成具有分离结构的髌内侧滑膜皱襞（根据Sakakibara分类为D型）。疼痛原因被认为是髌内侧滑膜皱襞受到撞击。通过关节镜使用钬激光消融滑膜皱襞。由于患者是一名处于生长阶段的13岁女孩，有可能生长导致双侧滑膜皱襞残余部分受到牵拉，侵入髌股关节内侧并增加张力，从而导致所报告的症状。
