(Fig 4-C.10) Sakakibara Classification

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📌 Sakakibara Classification

 

• The Sakakibara classification is a system used to describe medial patellar plicae based on their size and morphology. 
• This classification aids in identifying the potential for symptomatic issues related to the plicae.

 

✅ Type A

• Type A is characterized by a cord-like thin elevation of the synovial wall under the retinaculum. 
• This type does not cover the medial patellofemoral articular surface and is less likely to cause symptoms.

 

✅ Type B

• Type B presents a narrow shelf-like appearance that does not cover the medial femoral condyle. 
• Similar to Type A, Type B plicae are smaller and less likely to be symptomatic.

 

✅ Type C

• Type C is a larger shelf-like plica that covers the anterior surface of the medial femoral condyle. 
• This type extends to cover the articular surfaces, making it more likely to cause symptoms. 
• MRI findings often show a wide plica extending beyond the medial margin of the trochlear articular surface, corresponding to a Sakakibara Type C lesion.

 

✅ Type D

• Type D is similar to Type C but includes central defects known as fenestrations. 
• This type also covers the articular surfaces and is more frequently associated with symptoms, but it is relatively rare. 
• MRI findings for Type D lesions include thickening and increased intrasubstance signal on T2-weighted images, fenestration, focal fluid adjacent to the plica, and interposition between the patella and femoral trochlea on multiple contiguous images.

 

★ Clinical Significance

• Types A and B, which do not cover the medial patellofemoral articular surface, are generally smaller and less likely to cause symptoms. 
• In contrast, Types C and D, which extend to cover the articular surfaces, are more prone to being symptomatic due to their size and position. 
• Additionally, a more distended joint could pull the medial plica away from the medial condyle, making a Type C plica appear like a Type B plica.

 

References

1. Skeletal Radiol. 2018 Aug;47(8):1069-1086.
2. Skeletal Radiology (2020) 49:823–836.
3. RadioGraphics 2002; 22:775–784.
4. MRI Web Clinic — November 2018 Synovial Plicae of the Knee.

 

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