These were adapted for each database searched. The search terms used for the MEDLINE search are presented in Table 1. The electronic databases: MEDLINE, EMBASE, Science Direct and Scopus were searched from their inception to 1st of February 2013. Given this, the purpose of this systematic review is to determine the diagnostic accuracy of clinical tests and radiological imaging for the detection of MPP syndrome.Ī PRISMA compliant search strategy was used. However, with improved technology, the MPP may be more easily identifiable using non-invasive imaging techniques such as magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasonography (USS).ĭue to the complexity of the clinical presentation, the need for accurate clinical tests and radiological imaging is imperative, to improve the management of patients with MPP syndrome. Surgically, arthroscopy remains the gold standard for the diagnosis of a symptomatic MPP. Clinically, a number of physical examination tests have been reported within the literature. This can make the diagnosis of MPP syndrome challenging. MPP syndrome can mimic the presentation of other internal derangements of the knee. Fibrosis of the plica then occurs this is known as MPP syndrome. However, repetitive overuse of the knee from task-specific or athletic activities can cause progressive inflammation within and surrounding the MPP. The most common development of a pathologic MPP is through direct trauma and subsequent synovitis. Inflammation of the synovial tissue can lead to a thickening of the MPP, and in chronic cases, this can become inelastic. Due to the anatomical position of the MPP, it is prone to impingement between the patella and the medial femoral condyle during repetitive flexion activities. Today however, the MPP is recognized as a normal structure, the remnants of synovial septa from the embryonic development of the knee.Ī normal MPP is a thin, flexible soft-tissue structure, comprised of mainly elastic tissue. Previously plicae had been considered abnormal, pathological structures, frequently excised during arthroscopy regardless of evidence of pathology. Epidemiological studies have reported that the medial patellar plica (MPP) is the most commonly injured plicae due to its anatomical location. Note: occasionally, a small vertebral artery will terminate into a common AICA-PICA complex.The knee joint plicae are classified according to their corresponding anatomic site, hence the existence of suprapatellar, mediopatellar, infrapatellar, and lateral patella plicae. The posterior inferior cerebellar artery gives off the following arteries: supplies the vermis and adjacent hemisphere.The main trunk of the posterior inferior cerebellar artery usually bifurcates somewhere along the margin of the cerebellar tonsil into supplies branches to the cerebellar surface.contains the cranial loop, also known as the choroid point or choroid arch, an upward convex loop that has a constant relation to the 4 th ventricle and gives rise to choroidal arteries.courses in the cleft between the tela choroidea, inferior medullary velum rostrally, and superior pole of the cerebellar tonsil caudally.marks the transition between the proximal (medulla-supplying) and distal (cerebellum-supplying) parts of the posterior inferior cerebellar artery.contains the caudal loop, a downward convex loop that mostly remain superior to the foramen magnum but occasionally extend below it.courses along the posterolateral surface of the medulla and inferior cerebellar tonsil.variably courses (ascending or descending) along the side of the medulla near or between the origins of the 9 th, 10 th, and 11 th cranial nerve roots.courses along the front of the medulla at the level of the inferior olive.The segmental anatomy was defined microsurgically by Lister et al. occasionally loops around the cerebellar tonsil.10% arise from the basilar rather than vertebral artery.~20% arise extracranially, inferior to the foramen magnum.
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