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In Vivo Arthroscopic Behavior of the Infrapatellar Plica of the Knee

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ClinicalTrials.gov Identifier: NCT00643487
Recruitment Status : Completed
First Posted : March 26, 2008
Results First Posted : May 18, 2016
Last Update Posted : April 24, 2018
Sponsor:
Information provided by (Responsible Party):
Thomas Smallman, State University of New York - Upstate Medical University

Brief Summary:
Anterior knee pain has been an enigmatic problem for orthopedic surgeons. Recent studies, as well as the clinical observation of the principle investigator have suggested that arthroscopic resection of the infrapatellar plica (IPP), a vestigial remnant from embryonic development of no known clinical or biological significance, may eliminate this pain. The mechanism whereby this pain is related to the IPP is unclear. This study will document the mechanical behavior of the IPP, its kinematics, as recorded on video among a group of subjects who are undergoing arthroscopy. Radiographic visualization of the observed behavior will be obtained by injection of contrast material, and then fluoroscopic recording of a standard series of motions. The plica will then be resected to avoid any possibility of residual symptoms related to its presence. Further fluoroscopy of the knee without plical attachment, will allow the kinematic behavior to be assessed. The procedure will then be terminated.

Condition or disease Intervention/treatment
Anterior Knee Pain Syndrome Procedure: observation of the behavior of the infrapatellar plica

Detailed Description:

The infrapatellar plica (IPP) of the human knee is vestigial remnant of the embryologic division between the medial and lateral compartments of the knee, present in 85.5% of knees1, felt by some to be of no clinical significance other than acting as a block to visualization an movement during arthroscopy.2 S.J. Kim 3,4, C.R. Boyd 5, and B. Demirag 2006 have documented successful relier of anterior knee pain after resection of the IPP. This study seeks to assess the relationship between knee motion, activation of the extensor apparatus, and the IPP, in essence, the kinematics of the contents of the anterior compartment of the knee. The hypothesis to be evaluated is:

the infrapatellar plica is a structure of fundamental biomechanical significance, allowing the transmission of force from the extensor apparatus to the distal femur through the fat pad, and acting as a restraint and a modulator of fad pad mobility.

Subjects will be identified by the PI at their office visit. The subject will be consented. The consent will be discussed and verified in a second office visit before surgery. The subject will undergo arthroscopy specifically directed toward identifying and treating known pathology. Once this is finished, if an IPP is present, it will be injected with radiographic contrast material. A series of maneuvers will be performed involving passive and active motion of the knee and active contraction of the quadriceps apparatus. Videotape recording and fluoroscopy will be undertaken. The plica will be removed. Another fluoroscopy will be performed. The patient will be followed according to the standard practice for arthroscopy and the defined pathology.

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Study Type : Observational
Actual Enrollment : 8 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: In Vivo Arthroscopic Behavior of the Infrapatellar Plica of the Knee
Study Start Date : February 2006
Actual Primary Completion Date : January 2013
Actual Study Completion Date : January 2013

Group/Cohort Intervention/treatment
1
observation of the behavior of the infrapatellar plica
Procedure: observation of the behavior of the infrapatellar plica
Local anesthesia using bupivicaine will be initiated. The IPP, if present will be injected with contrast material. In order to minimize discomfort, lidocaine 1%, in as small a volume as possible, will be injected into the fat pad under direct vision to avoid any intra-articular damage from the #25 needle. Radiographic visualization will be verified and the knee taken through a full range of passive and active exercises. Active quadriceps contraction in the subject will be performed at 0, 15, 30 60 and 90 degrees of flexion. In so far as is technically possible, the behavior of the IPP will be videotaped and recorded on lateral fluoroscopy.
Other Name: Knee surgery




Primary Outcome Measures :
  1. Number of Participants With Successful Recording. [ Time Frame: During procedure, on average one hour. ]
    Observe the behavior of the IPP of the knee by fluoroscopy. A complete recording was obtained in 2 patients: this implied that the plica,central body, and fat pad were visualized. The patients then completed a series of manouevres which demonstrated the mechanical behavior of the infrapatellar plica-fat pad complex.



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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Inclusion:

Healthy subject >18 years of age, skeletally mature Pending knee joint arthroscopy.

Exclusion:

Active infection

Criteria

must be Healthy subject must be >18 years of age, skeletally mature must bePending knee joint arthroscopy.

may not have Active infection


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00643487


Locations
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United States, New York
SUNY Upstate Medical University
Syracuse, New York, United States, 13202
Sponsors and Collaborators
State University of New York - Upstate Medical University
Investigators
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Principal Investigator: Thomas V Smallman, MD State University of New York - Upstate Medical University
Publications:
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Responsible Party: Thomas Smallman, Associate Professor, State University of New York - Upstate Medical University
ClinicalTrials.gov Identifier: NCT00643487    
Other Study ID Numbers: Infrapatellar Plica
First Posted: March 26, 2008    Key Record Dates
Results First Posted: May 18, 2016
Last Update Posted: April 24, 2018
Last Verified: April 2018
Keywords provided by Thomas Smallman, State University of New York - Upstate Medical University:
Knee physiology
Anterior compartment knee
Infrapatellar plica
Ligamentum mucosum
Enthesis organ
Fat pad of the knee
Patellofemoral kinematics
Additional relevant MeSH terms:
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Patellofemoral Pain Syndrome
Joint Diseases
Musculoskeletal Diseases