Anterior knee pain has been relieved by resection of the infrapatellar plica (IPP). The question is: How? The hypothesis is: the IPP acts as an intra-articular ligament, a mechanical link between the forces of knee motion, the fat pad (FP) and the distal femur, holding the FP captive through the arc of motion. Release of the IPP severs this link, allowing the highly innervated FP to move freely. This may allow any underlying pathologic process to heal. Anatomic dissection: In 12 knees, the extensor apparatus was released from the femur and retracted distally allowing relationships to be examined. Cadaver studies: Lateral fluoroscopy was used as well as direct arthroscopic visualization to control implantation of tantalum beads or radiographic contrast material in the FP and IPP. The knee was taken through the arc of motion repeatedly. The femoral attachment of the IPP was then released and knee motion repeated. Traction on the extensor apparatus simulated active motion. In-Vivo Study: The IRB approved study of 12 volunteers undergoing planned knee arthroscopy under local anesthesia. Contrast was placed in the FP and IPP under lateral fluoroscopic control. Passive, then active motion then a quads-set manoeuvre was performed. The IPP was resected and knee motion again recorded.Purpose
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