Abstract

Medial shelf may either give arise pain to the extensor mechanism of the knee or simulate a tear of the medial meniscus. Nevertheless its involvement as a cause of knee derangement is often overestimated and an arthroscopic synovial fold resection could be unnecessary or ineffective. The authors report the results of the conservative treatment of an athletic population suffering by medial shelf anterior knee pain. The mean age ranged from the end of the bone growth to 25 years and the criteria of selection included patient's history, clinical findings and radiological data. Anteroposterior and lateral plan radiographs, including skyline patellar view with the knee flexed to 45 degrees were made of the symptomatic knee. Moreover all involved knees were studied at either CT(double contrast)arthrography or MRI with the aim to exclude those patients with anterior knee pain due to different causes. From January 1992 to December 1994, 22 athletes (28 knees) from different sports were treated with a local injection of a steroid an anaesthetic into the medial shelf. In 19 knees after 10 to 15 days the injection was repeated. At a minimum 5 years follow-up 16 athletes (22 knees) were reviewed. Sixteen cases had a full return to activity while the reminder (6 knees) underwent an arthroscopic resection of the painful shelf. The commonest causes of anterior knee pain in the young active population are listed and caution must be exercised in making diagnosis of painful shelf until different problems of the extensor mechanism have been ruled out of the differential diagnosis. Intraplical steroid injection is easy to make, repeatable and suitable as an office treatment of a symptomatic plica. No articular damage due to the medication was seen at an early (6 knees) or long term (5 knees) arthroscopy. The method is advisable as first step in the treatment of a painful medial shelf in absence of other knee derangement as well as an effective procedure in the athlete who refuses the arthroscopy or wishes to defer it. Verf.-Referat