Lyu Shaw-Ruey, Lee Ching-Chih, Hsu Chia-Chen
From the Joint Center (SRL, CCH), Center for Clinical Epidemiology and Biostatistics (CCL), Dalin Tzu-Chi General Hospital, Chiayi, Taiwan; and School of Medicine,Tzu-Chi University (SRL, CCL), Hualien, Taiwan.
Medicine (Baltimore). 2015 Apr;94(16):e736. doi: 10.1097/MD.0000000000000736.
Knee pain is a prevailing health problem of middle and old age. Medial plica-related medial abrasion syndrome (MAS), although a well-known cause of knee pain in younger individuals, has rarely been investigated in older individuals. This prospective study was conducted to investigate the prevalence and clinical manifestations of this syndrome as a cause of knee pain in middle and old age. The outcomes of arthroscopic treatment for this syndrome were also evaluated.A total of 232 knees of 169 patients >40 years of age (41-82, median: 63 years old) suffering from chronic knee pain were analyzed. The clinical diagnosis, predisposing factors, presenting symptoms, and physical signs were investigated. The sensitivity and specificity of each parameter of the clinical presentation for the diagnosis of MAS were evaluated after confirmation by arthroscopy. For patients with MAS, the roentgenographic and arthroscopic manifestations were investigated, and arthroscopic medial release (AMR) was performed. The outcomes were evaluated by the changes in the pain domain of the Knee Society scoring system and by patient satisfaction. The prevalence of medial plica was 95%, and osteoarthritis (OA) was the most common clinical diagnosis. Symptoms of pain and crepitus in motion and local tenderness during physical examination were the most sensitive parameters for the diagnosis. A history of a single knee injury combined with local tenderness and a palpable band found during physical examination were the most specific parameters for the diagnosis. The majority of patients suffering from this syndrome were successfully treated using AMR, yielding a satisfaction rate of 85.5% after a minimum of 3 years.MAS is a common cause of knee pain in middle and old age and can be effectively treated by AMR. Its concomitance with OA warrants further investigation.
膝关节疼痛是中老年人群中普遍存在的健康问题。虽然内侧皱襞相关的内侧磨损综合征（MAS）是年轻个体膝关节疼痛的一个众所周知的原因，但在老年个体中很少被研究。本前瞻性研究旨在调查该综合征作为中老年膝关节疼痛原因的患病率和临床表现。同时也评估了针对该综合征的关节镜治疗效果。
对169例年龄>40岁（41 - 82岁，中位数：63岁）患有慢性膝关节疼痛患者的232个膝关节进行了分析。调查了临床诊断、诱发因素、症状表现及体征。在关节镜检查确诊后，评估了临床表现各参数对MAS诊断的敏感性和特异性。对于MAS患者，研究了其影像学和关节镜表现，并进行了关节镜下内侧松解术（AMR）。通过膝关节协会评分系统疼痛领域的变化及患者满意度来评估治疗效果。内侧皱襞的患病率为95%，骨关节炎（OA）是最常见的临床诊断。疼痛、活动时弹响症状以及体格检查时的局部压痛是诊断最敏感的参数。单次膝关节损伤史合并局部压痛以及体格检查时可触及的条索是诊断最具特异性的参数。大多数患有该综合征的患者通过AMR治疗成功，至少3年后满意度为85.5%。
MAS是中老年膝关节疼痛的常见原因，可通过AMR有效治疗。其与OA的并存情况值得进一步研究。
