Surgical and conservative management of medial plica syndrome: A systematic review and meta-analysis of functional outcomes.

Purpose: Knee plica syndrome is a common condition that often presents diagnostic challenges due to its symptom overlap with other knee pathologies. Surgical resection has traditionally been the common treatment; however, recent studies have questioned its necessity, proposing conservative interventions as effective alternatives. The aim of the current systematic review and meta-analysis is to analyse and compare efficacy of surgical and conservative treatment. Methods: A comprehensive review and meta-analysis was conducted on six clinical trials published between 2008 and 2023, focusing on surgical and conservative treatments for isolated knee plica syndrome. Rigorous inclusion criteria filtered studies that directly compared surgical and conservative methods. The risk of bias was assessed using the ROBINS-I tool for nonrandomized studies and RoB-2 for randomised trials. The studies were evaluated using patient-reported outcome measures and the pain score. The meta-analysis was carried out using the Lysholm Knee Score. Furthermore, complications and revisions surgery were recorded when reported. Results: The total number of patients investigated was 527 of which 284 were female (57%) and 209 males (43%). Patients were divided in two group according to the received treatment: both surgical and conservative treatments demonstrated improvements in knee function (p < 0.05). In the 12-24 month follow-up period, the pooled mean difference for functional improvement was 24.5 (95% confidence interval [CI]: 18.7-30.2, p < 0.001), with no statistically significant difference favouring either approach (p > 0.05). However, heterogeneity was substantial (I² = 85.3%). No complications were reported with both treatment strategies. Conclusion: This study provides valuable insights into the treatment of knee plica syndrome, advocating for a conservative-first approach. Establishing standardised protocols could enhance diagnostic precision and patient outcomes, ultimately optimising management strategies for this complex knee pathology. Level of Evidence: Level IV.