The elbow plica: a systematic review of terminology and characteristics

Background: There has been a lack of evidence regarding the structure of the elbow plica, or synovial fold. Inconsistency remains regarding the correct terminology, prevalence, and investigation used to understand this anatomic structure.

Methods: For this systematic review, we searched the PubMed, Ovid-MEDLINE, Cochrane, Google Scholar, and Embase databases using keywords as well as medical subject headings for English-language studies. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results: We included 27 articles in this review. "Plica" was the most commonly used terminology (33%). The prevalence of plicae in asymptomatic and symptomatic patients was 77% and 97%, respectively. Provocative factors were sporting activities (57%), including those performed by professional athletes, and heavy labor (43%). Lateral elbow pain represented the most common symptom (49%). Magnetic resonance imaging was the most commonly used diagnostic modality (64%). On the magnetic resonance imaging scans of symptomatic patients, the most common location of the plica was the posterolateral region (54%) and its thickness was a minimum of 3 mm. In 2 studies that included symptomatic patients, the plica was found to cover more than one-third of the radial head.

Conclusion: Plicae are prevalent in both asymptomatic and symptomatic patients. Consideration of the pathologies associated with an elbow plica helped identify the following: (1) its thickness is >3 mm and (2) its location is in the posterolateral aspect and/or it covers more than one-third of the radial head quadrant.