Nicholas Stubbings1, Toby Smith2. 1. Charlton Athletic Football Club, London, UK. 2. Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK. Electronic address: toby.smith@uea.ac.uk.
Abstract
BACKGROUND: The diagnosis of medial patella plica (MPP) syndrome is challenging due to poor clinical knowledge and controversies surrounding clinical and radiological diagnosis. The purpose of this study is to determine the diagnostic accuracy of clinical tests and radiological imaging in the detection of MPP syndrome. METHODS: A systematic review of the electronic databases EMBASE, MEDLINE, Science Direct and Scopus was undertaken. All studies which compared the accuracy of a clinical test, magnetic resonance imaging (MRI) or ultrasound (USS) (index tests) to assess the presence of MPP syndrome, against a surgical procedure (reference test) were included. Methodological appraisal using the QUADAS tool was conducted. The data was analyzed with pooled sensitivity and specificity meta-analyses with 95% confidence intervals. RESULTS: Seven studies including 492 knees were reviewed. The MPP (physical examination) test (sensitivity=0.90; specificity=0.89) and USS (sensitivity=0.90; specificity=0.83) demonstrated the greatest diagnostic test accuracy. MRI demonstrated a sensitivity of 0.77 and specificity of 0.58. The literature presented with moderate methodological quality. CONCLUSIONS: The MPP test and USS are valuable in the diagnosis of MPP syndrome. The reference standard for future research in this area should be the resolution of symptoms following MPP resection, instead of arthroscopic evaluation. LEVEL OF EVIDENCE: 3a.
BACKGROUND: The diagnosis of medial patella plica (MPP) syndrome is challenging due to poor clinical knowledge and controversies surrounding clinical and radiological diagnosis. The purpose of this study is to determine the diagnostic accuracy of clinical tests and radiological imaging in the detection of MPP syndrome. METHODS: A systematic review of the electronic databases EMBASE, MEDLINE, Science Direct and Scopus was undertaken. All studies which compared the accuracy of a clinical test, magnetic resonance imaging (MRI) or ultrasound (USS) (index tests) to assess the presence of MPP syndrome, against a surgical procedure (reference test) were included. Methodological appraisal using the QUADAS tool was conducted. The data was analyzed with pooled sensitivity and specificity meta-analyses with 95% confidence intervals. RESULTS: Seven studies including 492 knees were reviewed. The MPP (physical examination) test (sensitivity=0.90; specificity=0.89) and USS (sensitivity=0.90; specificity=0.83) demonstrated the greatest diagnostic test accuracy. MRI demonstrated a sensitivity of 0.77 and specificity of 0.58. The literature presented with moderate methodological quality. CONCLUSIONS: The MPP test and USS are valuable in the diagnosis of MPP syndrome. The reference standard for future research in this area should be the resolution of symptoms following MPP resection, instead of arthroscopic evaluation. LEVEL OF EVIDENCE: 3a.