The article outlines the main points of the examination of patients with the SPS. Based on the analysis of
the literature and our own experience, diagnostic criteria for this pathology are presented.
HISTORY AND METHODS
Undoubtedly, one of the most important stages in the diagnosis of knee pathology is obtaining an appropriate
history of the disease in a patient. Patients may report an aggravation of symptoms on excessive or severe
traumatic effects associated with flexion and extension of the knee. Intense painful sensations are more
common in athletes with poor quadricep tone or significant muscular imbalance around the knee, because
synovial folds are directly related to the articular surfaces of the knee and are indirectly attached to the muscles
of the quadriceps, while the folds change dynamically during knee activity [4].
The diagnosis should be suspected in patients of any age. Also, it should be noted that aggravation of
symptoms is not a mandatory clinical course of the disease and for this reason the problem of identifying
patients with a long asymptomatic syndrome is still relevant. Some patients report blunt trauma or twisting
trauma, which usually lead to the development of effusion. Prolonged pain in the projection of the medial
articular surface of the knee is usually associated with the development of fibrosis [9].
Pain syndrome sometimes occurs after intense passive or active physical exertion (repeated flexion and
extension of the knee), when climbing or descending stairs, squatting, getting up after prolonged sitting [5]. In
addition, patients may note pain in the knee during the sitting itself [1, 10]. Patients commonly report
intermittent nonspecific anterior knee pain, snapping, clicking, catching, clunking, grinding, “giving way,” or a
popping sensation along the inside of the knee during flexion and extension. The knee may be tender to the
touch, swollen, and stiff (Table 1) [11].
Thus, the pain that occurs on the anterior articular surface of the knee is a cardinal symptom and is
present in almost all patients with this pathology.
Table 1. Symptoms and signs of knee synovial plica syndrome
• Anterior knee pain
• Snapping sensation along the inside of the knee as the knee is bent
• Clicking, catching, clunking, grinding, popping
• Tender to the touch
• Felt as a tender band underneath the skin
• Knee effusion, swelling
• Pain on squatting
• Locking, stiffness, giving way
CLINICAL EXAMINATION
In a clinical examination, the surface of the knee may be soft to the touch, swollen or hard. Symptoms are often
clinically indistinguishable from other intra-articular pathologies of the knee, such as damage to the meniscus
and articular cartilage, making it difficult to diagnose [2]. Therefore, physical methods are insufficient.
In turn, clinical diagnosis is supported by special functional tests and instrumental imaging methods.
When examining the knee, it is important to make sure that the patient is relaxed, which is usually achieved by
taking a supine position on the back while supporting both legs.
The abnormal medial plicae is palpated in the form of a cord located 1 cm medially from the superior of the
patella. Some patients may experience a feeling of moderate pain when palpating the location of the synovial
fold. In this case, an important point is to conduct a comparative study with the second knee to see if there is a
difference in the intensity of pain.
As with any other physical examination, it is important to simultaneously determine whether there are
other possible pathologies in the structures of the knee, which are located close to the synovial folds. In case of
acute injuries, other common pathologies of the knee soft tissues, such as meniscal and cruciate ligament
injuries, should be excluded.
The Hughston’s plica test (Figure 2) and Stutter test (Figure 3) are provocative tests commonly used to
support a diagnosis of SPS [5, 9, 10]. These tests are considered to be more supportive of the diagnosis when
To cite this paper: Irismetov M E, Tadjinazarov M B, Kholikov A M, Shamshimetov D F, Usmonov F M and Rajabov Q N. 2019. Diagnostic criteria for the synovial
75