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MR Imaging of Infrapatellar Plica Injury

R. Lee Cothran1, Philip M. McGuire1,2, Clyde A. Helms1, Nancy M. Major1 and David E. Attarian3

1 Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710.
2 Present address: Radiology Alliance, P.A., 210 25th Ave. N., Ste. 602, Nashville, TN 37203.
3 Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710.



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  		Fig. 1A. —Normal infrapatellar plica. Schematic drawing of knee in sagittal section through intercondylar notch shows infrapatellar plica (black arrow) extending from inferior pole of patella (P) or immediately adjacent fat, through Hoffa's fat pad, to intercondylar notch of femur anterior to anterior cruciate ligament (white arrow).

 


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  		Fig. 1B. —Normal infrapatellar plica. Sagittal fast spin-echo T2-weighted MR image (TR/TE, 4000/72) with fat suppression through intercondylar notch shows normal infrapatellar plica as thin, linear low-signal-intensity structure (black arrow) in Hoffa's fat with more prominent intercondylar component (straight white arrows) lying anterior to anterior cruciate ligament (curved white arrows), proximal attachment in intercondylar portion of femur, and distal visualized portion attaching to prominent transverse ligament.

 


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  		Fig. 1C. —Normal infrapatellar plica. Sagittal fast spin-echo T2-weighted MR image (4000/72) with fat suppression through intercondylar notch shows partially resorbed or less prominent intercondylar infrapatellar plica (arrows), with portion in Hoffa's fat as only visible component on MR image.

 


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  		Fig. 2A. —18-year-old woman soccer player with anterior knee pain. Sagittal fast spin-echo T2-weighted MR image (TR/TE, 4000/69) with fat suppression through intercondylar notch shows curvilinear high T2 signal along course of infrapatellar plica (arrow). Fluid signal immediately anterior to anterior cruciate ligament in intercondylar notch may be related to infrapatellar plica avulsion or may simply represent joint fluid. Other findings on MR imaging included discoid lateral meniscus and mediopatellar plica (not shown). At arthroscopy (not shown), infrapatellar plica was thickened and avulsed from its femoral attachment, and redundant infrapatellar plica interfered with full extension. Infrapatellar plica was resected; after surgery, patient was asymptomatic and resumed playing soccer.

 


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  		Fig. 2B. —18-year-old woman soccer player with anterior knee pain. One year later patient injured her contralateral knee and suffered bucket-handle tear of discoid lateral meniscus. Sagittal fast spin-echo T2-weighted MR image (4000/70) with fat suppression through intercondylar notch shows fluid signal along course of infrapatellar plica (white arrows), which was interpreted as injury to infrapatellar plica. Infrapatellar plica was arthroscopically resected, and meniscus was débrided. Fragment from bucket-handle meniscus tear can be seen in posterior joint (black arrow).

 


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  		Fig. 3. —38-year-old woman with skiing injury. Sagittal fast spin-echo T2-weighted MR image (TR/TE, 4000/67) with fat suppression through knee 6 months after injury shows fluid signal along course of infrapatellar plica (arrows) interpreted as torn anterior cruciate ligament with associated rupture of infrapatellar plica. At arthroscopy 2 months later (not shown), scar tissue was found in expected position of infrapatellar plica, suggesting that plica had been injured.

 


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  		Fig. 4. —22-year-old male collegiate basketball player with bilateral anterior knee pain. Sagittal fast spin-echo T2-weighted MR image (TR/TE, 4000/73) with fat suppression through left intercondylar notch shows curvilinear high signal intensity along course of infrapatellar plica (arrows). Knee was otherwise normal.

 

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