• 1

    Soames R (ed): “Skeletal System,” in Gray’s Anatomy, 38th Ed, ed by P Williams, p 494, Churchill Livingstone, New York. ,1995. .

  • 2

    Dorland’s Illustrated Medical Dictionary, 27th Ed, WB Saunders, Philadelphia. ,1988. .

  • 3

    Engle R, Bogduk N: The menisci of the lumbar zygapophyseal joints. .J Anat 135::795. ,1982. .

  • 4

    Giles L, Taylor R: Human zygapophyseal joint capsule and synovial fold innervation. .Br J Rheumatol 26::93. ,1987. .

  • 5

    Singer K, Giles L, Day R: Intra-articular synovial folds of thoracolumbar junction zygapophyseal joints. .Anat Rec 226::147. ,1990. .

  • 6

    Howell S, Galinat B: The glenoidlabral socket: a constrained articular surface. .Clin Orthop 243::122. ,1989. .

  • 7

    Chang H, Found E, Clark C, et al: Meniscus-like synovial fold in the atlantoaxial (C1–C2) joint. .J Spinal Disord 5::227. ,1992. .

  • 8

    Patton G, Tursi F, Zelichowski J: The dorsal synovial fold of the first metatarsophalangeal joint. .J Foot Surg 26::210. ,1987. .

  • 9

    Hollander JD, Lidtke RH, Lai JY: The labrum of the calcaneocuboid joint. .J Foot Ankle Surg 37::308. ,1998. .

  • 10

    Fiset ME, Gilbert C, Poubelle PE, et al: Human neutrophils as a source of nociception: a novel link between pain and inflammation. .Biochemistry 42::10498. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Smith MD, Barg E, Weedon H, et al: Microarchitecture and protective mechanisms in synovial tissue from clinically and arthroscopically normal knee joints. .Ann Rheum Dis 62::303. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Jay GD, Tantravahi U, Britt DE, et al: Homology of lubricin and superficial zone protein (SZP): products of megakaryocyte stimulating factor (MSF) gene expression by human synovial fibroblasts and articular chondrocytes localized to chromosome 1q25. .J Orthop Res 19::677. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    An YH, Draughn RA: “Mechanical Testing of Bone and the Bone-Implant Interface,” in Basic Concepts of Mechanical Property Measurement and Bone Mechanics, p 33, CRC Press, New York. ,2000. .

    • Crossref
    • Export Citation
  • 14

    Habermeyer P, Schuller U, Wiedemann E: The intra-articular pressure of the shoulder: an experimental study on the role of the glenoid labrum in stabilizing the joint. .Arthroscopy 8::166. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Yu S, Sether L, Haughton V: Facet joint menisci of the cervical spine: correlative MR imaging and cryomicrotomy study. .Radiology 164::79. ,1987. .

  • 16

    Zidorin T: Classification of the suprapatellar septum considering ontogenetic development. .Arthroscopy 8::459. ,1992. .

  • 17

    Ogata S, Uhthoff H: The development of synovial plicae in human knee joints: an embryological study. .Arthroscopy 6::315. ,1990. .

  • 18

    Moon M, Kim J, Ok I: The normal and regenerated meniscus in rabbits. .Clin Orthop 182::264. ,1984. .

  • 19

    Kim J, Moon M: Effect of synovectomy upon regeneration of meniscus in rabbits. .Clin Orthop 141::287. ,1979. .

  • 20

    Steinbach LS, Palmer WE, Schweitzer ME: Special focus session: MR arthrography. .Radiographics 22::1223. ,2002. .

  • 21

    Awaya H, Schweitzer ME, Feng SA, et al: Elbow synovial fold syndrome: MR imaging findings. .AJR Am J Roentgenol 177::1377. ,2001. .

  • 22

    Huh YM, Suh JS, Lee JW, et al: Synovitis and soft tissue impingement of the ankle: assessment with enhanced three-dimensional FSPGR MR imaging. .J Magn Reson Imaging 19::108. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Zellner A, Dihlmann S, Lehnert M: Impingement symptoms caused by a synovial fold in the glenoid fossa projecting into the sublabral hole. .Arthroscopy 11::112. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Lundeen RO: “Arthroscopic Techniques of the Ankle and Foot,” in Manual of Ankle and Foot Arthroscopy, p 45, Churchill Livingstone, New York. ,1992. .

  • 25

    Patel D: Arthroscopy of the plicae, synovial folds and their significance. .Am J Sports Med 6::217. ,1978. .

  • 26

    Oloff L, Schulhofer S, Fanton G, et al: Arthroscopy of the calcaneocuboid and talonavicular joints. .J Foot Ankle Surg 35::101. ,1996. .

  • 27

    Molloy S, Solan MC, Bendall SP: Synovial impingement in the ankle: a new physical sign. .J Bone Joint Surg Br 85::330. ,2003. .

  • 28

    Johnson LL: “Synovial Surgery,” in Diagnostic and Surgical Arthroscopy: The Knee and Other Joints, 2nd Ed, p 360, CV Mosby, St Louis. ,1981. .

  • 29

    Kanbe K, Takemura T, Takeuchi K, et al: Synovectomy reduces stromal-cell–derived factor-1 (SDF-1) which is involved in the destruction of cartilage in osteoarthritis and rheumatoid arthritis. .J Bone Joint Surg Br 86::296. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Anatomy, Biomechanics, and Surgical Approach to Synovial Folds Within the Joints of the Foot

Roy H. Lidtke Weil Foot and Ankle Institute, Des Plaines, IL.

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 DPM, CPed
Joe George Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL.

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The presence of synovial folds in various joints of the foot has been previously documented. The function and clinical significance of these structures within the joint have not been established. Histologically they are considered anatomically different from a meniscus primarily owing to their makeup of loose connective tissue with nerve fibrils and several synovial cell layers. We hypothesize that the function of these folds is similar to that of the menisci: to increase joint congruity and stability. We further hypothesize that these folds will be present in joints of the foot that require greater stability. To demonstrate this, 41 fixated cadaveric feet were sectioned in the sagittal plane and the incidence and locations of the synovial folds were documented. Three fixated cadaveric feet were evaluated using a materials testing machine. The first metatarsophalangeal joint was incised, and the presence of the synovial fold was documented. The joint was then taken through its range of motion with and without the synovial fold while data on the force and displacement were collected. The steps were then repeated for the ankle joint. The results showed statistically stiffer ankle and first metatarsophalangeal joints with the synovial fold present, as determined by the stress-strain curve. On the basis of the presence and location of these synovial folds, we demonstrated arthroscopic surgical approaches to many of the documented joints that contain these folds. Because the folds contain synovial cells and vascular tissue, damage to them can result in considerable pain. In such cases, arthroscopic surgery would be of benefit. Further research may indicate whether they need to be salvaged during joint procedures to facilitate normal joint function or should be removed to reduce postoperative complications. (J Am Podiatr Med Assoc 94(6): 519–527, 2004)

Corresponding author: Roy H. Lidtke, DPM, CPed, Weil Foot and Ankle Institute, 1455 E Golf Rd, Ste 131, Des Plaines, IL 60016.