The Correlation Between Patellfemoral Pain And Neuron-element In The Symptomatic Medial Plica: A Preliminary Clinical Pathology Study

Medial plicais the normal synovial membrane structure in knee. A mesenchymal tissue or un chondrified blastema fills the space between the distal femoral and the proximal tibial epiphyses resorbs uncompletely in areas to between the femoral epiphysis and the patella to form the mediopatellar plica. The medial plicacommonly is presented as a normal finding of the knee, as well as a lesion, an ailment, a pathologic condition, or a hypertrophy.Many authors focus on the definition of medial plica as either normal or abnormal.Histologic study of medial plicaconfirms mechanical and chronic conflict with pathologic changes as deep fibrosis and abrasion of the superficial synovial layer. Such as infiltration of inflammatory cells and hypertrophy of a synovitis, thickening of vessels walls are inconstant.But these signs are not characteristic. Richmond and McGinty reported 40% of the patients with good results after plica resection had a normal pathology examination; Klein and Hanspal reported that 15-66% of the patients felt obviously patellfemoral pain ,which had good results after plica resection,found plica fibrosis ,33% found abnormal findings with inflammation.It is necessary to do more research to demonsrate the real difference between normal and abnormal mediopatellar plica.The mediopatellar plica syndrome almost resut patellfemoral pain.The anatomy and fuction need further more research.Some authors reported that medial plicaassociated lesion of cartilage result pain.But we found that some patients felt pain even though their patellfemoral cartilage had no lesion. Thin medial plicae can in fact be symptomatic, and the patient's complaints relieved by excision. Wide, tense, and thick plicae may be totally asymptomatic, as there is no strict relationship between the aspect of the plica and the possible symptoms.Neuro-immunohistology suggest that innervation of synovial membrane upgoing in the patients who felt anterior knee pain.We presume that the innervation of medial plicae response for the anterior knee pain. The study focus on the neurotomia of plica by using neuron-immunology.Obtaining medial plicae by knee arthroscope.,Two indirect immunohistological techniques were employed for the semiquantitative analysis of protein gene product(PGP9.5),substance P(SP).Compare the density of innervation among the three groups by paired t-test,one -way analysis of variance (ANOVA) and Student-Newman-Keuls Test (SNK).Evaluate the correlation between the density of innervation and the scores of VAS by Wilcoxon rank sum test and Spearman correlation analysis.The results were as followed:①The innervation in medial plicae do exist,there are three type of nerve fiber: free fiber,perivascular neural network around the blood vassel,nerve fiber bundle.②The density of nerve fiber in the basilar part is higher than edge area.Decide the basilar part to be the test site.③The density of nerve fiber of medial plicae is higher than superior plica.④The density of nervefiber of the medial plicasyndrome patients is higher than negative control group.⑤There is positive correlation between the density of nerve fiber and pain level.Main conclusions included: Medial plica syndrome is an important reason for Patellfemoral pain syndrome.Innervation upgoing and density of nerve fiber upgrade in medial plica syndrome patients,substance P are significantly correlated with pain.