Methods: The minimum follow-up was 3 years. : A Meta-Analysis. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . It results in postoperative laxity, but rarely in frank instability. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mucoid degeneration of the ACL is suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences in MRI is identified in a patient with physically intact ligament and no obvious trauma history. Mucoid degeneration of the ACL is a rare cause of knee pain.1-8) This lesion of the ACL was first reported by Kumar et al.3) in 1999. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. However, symptomatic instability was not common. Despite the low rate of complications in all studies, there was a high incidence of postoperative knee laxity, demonstrated by a positive Lachman test, in most studies. Please enable it to take advantage of the complete set of features! After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Conclusions Our study provides further evidence that arthroscopic total or partial excision of anterior cruciate ligament is a safe and effective treatment for mucoid degeneration of the anterior . Epub 2010 May 8. J Orthop. government site. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Would you like email updates of new search results? the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Bethesda, MD 20894, Web Policies Mucoid degeneration of the anterior cruciate ligament: a case report. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. https://doi.org/10.2214/ajr.182.5.1821283, Article official website and that any information you provide is encrypted Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. MDACL is differentiated from synovial cysts of the anterior cruciate ligament (ACL) where, in MDACL, mucoid tissue intermingles within ACL fibres and is not contained within a cyst [3]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Copyright 2010 Elsevier Masson SAS. (48.2% (14/29 patients) with symptomatic instability), which may be due to the large number of patients with total resection of the ACL (58.6% (17 out of 29 patients)) (Table 4). -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Knee Surg Sports Traumatol Arthrosc. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Mucoid degeneration of the anterior cruciate ligament. Unable to load your collection due to an error, Unable to load your delegates due to an error. Khanna et al. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. An official website of the United States government. 2007;245 (3): 916-7. Level of evidence: eCollection 2022 May-Jun. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. 2020 Jun 2. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: a case report. The rate of simultaneous meniscectomy ranged from 13 to 44%. Clipboard, Search History, and several other advanced features are temporarily unavailable. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. It can cause pain and to a meniscal tear. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Conditions that resembles the clinical findings are: Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. MUCOID DEGENERATION OF ACL - ARTHROSCOPIC TREATMENT 2,375 views Sep 15, 2019 23 Dislike Dr. Prateek Joshi- Ortho 1.02K subscribers Notice Age-restricted video (based on Community Guidelines). 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. Individuals with mucoid degeneration of the ACL were excluded. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Mucoid degeneration of the anterior cruciate ligament. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. Hide glossary Glossary. -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Careers. [6], in 62% of patients (18 of 29) in the study of Lintz et al. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Before Unauthorized use of these marks is strictly prohibited. Bookshelf Part of Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. eCollection 2013. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . Knee Surgery, Sports Traumatology, Arthroscopy. We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Before The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Generally, we know little about this condition. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. Careers. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). All patients (100%, n=11) reported a good to very good surgery satisfaction. . report that one patient had ACL reconstruction simultaneously after the ACL debridement. The purpose of this study was to investigate the outcome of management of MDACL by performing a systematic review of methods of treatment that have been reported. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Bergin et al. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Imaging: Plain radiographs In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Case report: Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, most pronounced at 6-7 and small disc herniations at 5-6 and C4-5, with slight interval progression at 5-6. . Arthroscopy. ACL tears don't heal as such. 1. Postoperative pain relief was reported in seven studies. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. An anterior cruciate ligament (ACL) mucoid degeneration, along with tears and anterior cruciate ligament ganglion cysts, is a relatively common cause of increased signal within the. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Average patient age was 49 (22 to 68) years. Arthroscopy. TS designed the project, literature search and wrote the manuscript. Bone and joint imaging. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. What causes mucoid degeneration of ACL? (Table 3). 2007;90(3):1923. Arthroscopic debridement of the ACL resulted in good pain relief and improved range of movement in all studies, with postoperative improvement in the knee scores. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. It results in postoperative laxity, but rarely in frank instability. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity that has been found in patients with pain and limited range of motion of the knee in association with a bulky ACL shown on magnetic resonance imaging (MRI). Management of mucoid degeneration of the anterior cruciate ligament: a systematic . Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. An official website of the United States government. and transmitted securely. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. [18] did not comment on an association between MDACL and chondral or meniscal lesions: after the exclusion of that report, the total number of patients with associated chondral lesions was 226 out of 275 patients (82%) and 190 patients had meniscal lesions (69%). https://doi.org/10.1016/j.arthro.2003.11.030, Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. An official website of the United States government. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. PubMed International Journal of Orthopaedics. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. 2011. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. MM and A performed the literature search, and data analysis. The inclusion criteria for this study were (1) studies including symptomatic patients with mucoid degeneration of the ACL, (2) studies of 10 or more patients, (3) a minimum of 6months follow up and (4) patients treated conservatively or surgically (arthroscopic debridement with or without simultaneous ACL reconstruction). Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. For non-comparative studies, this consists of eight questions. reported the largest percentage of patients (27.5%) with a positive pivot test. Patients and methods: Results: https://doi.org/10.1007/s00167-011-1433-0, Article Arthroscopic findings. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. 2011. Introduction: Unable to load your collection due to an error, Unable to load your delegates due to an error. Bergin D, Morrison WB, Carrino JA et-al. -. Skelet Radiol 30(6):312315. Mumbai, Maharashtra, India. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Cite this article. Would you like email updates of new search results? eCollection 2021. Level of Evidence: Level IV. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Along with that, it also controls the internal rotation. 1. Federal government websites often end in .gov or .mil. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. reported on the co-existence of mucoid degeneration and ganglia of the ACL. Method. Average postoperative International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were 71.2 (42.5 to 92.0) and 78.2 (26.4 to 99). Indian J Orthop 48(2):197202. bling. Online ahead of print. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. A long duration of non-specific knee pain in a patient should be evaluated with MRI. (61years), which was the largest study and represented more than one third of the total patients included in this review. official website and that any information you provide is encrypted -, Fealy S, Kenter K, Dines JS, Warren RF. did not report on this. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. However, in most studies a proportion of patients simultaneously underwent other arthroscopic procedures for associated pathological knee conditions (44% meniscectomies in the study of Cha et al.). GG and AM interpreted the results and reviewed the manuscript. Morice et al. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. 2 ). Furthermore, this raises the question as to whether the symptoms (pain and diminished range of movement) were solely due to MDACL and not secondary to other associated pathological conditions. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. Intact fibers are best seen on T2WI. The presence of intraligamentous mucoid degeneration in the ACL is demonstrated as a source of knee pain without instability and partial ACL debridement did not preclude adequate knee stability. 2001;17(9):E37. No treatment is usually required. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. 2011 Aug 1;19(8):1326-33. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Ligaments are very tough, fibrous tissue structures. https://doi.org/10.1046/j.1445-2197.2003.02748.x, Ekhtiari S, Horner NS, Bedi A, Ayeni OR, Khan M. The learning curve for the Latarjet procedure: a systematic review. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. 2011. This may support the theory that it is a degenerative process. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). 2011. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a well-recognized pathology characterized by the degradation of collagen fibers and infiltration of a mucoidlike substance, [1,2 . Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Google Scholar, Chudasama CH, Chudasama VC, Prabhakar MM (2012) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. https://doi.org/10.4055/cios.2018.10.3.307, University Hospitals of Derby and Burton, Uttoxeter Rd, Derby, DE22 3NE, UK, Trauma and Orthopaedic Speciality Trainee, West Midlands Deanery, Birmingham Rotation, Birmingham, UK, University Hospitals Plymouth NHS Trust, Plymouth, UK, University of Alexandria, Alexandria, Egypt, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK, You can also search for this author in Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. All nine studies assessed the outcome of arthroscopic debridement of MDACL. Dietary management and various treatments Scanning and diagnostic . It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased signal intensity and a celery stalk appearance of intact fibers. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Mucoid degeneration of the ACL is suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences in MRI is identified in a patient with physically intact ligament and no obvious trauma history. 8600 Rockville Pike 3. Arthroscopic diagnostic criteria [7] are (1) continuous ACL fibres, (2) increased ACL volume, (3) yellowish-coloured material expressed on palpation and (4) loss of ACL synovial lining. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. https://doi.org/10.1302/0301-620X.81B2.0810304, Article 2004;182 (5): 1283-7. The pathogenesis remains controversial. (A) Bulging of the hypertrophied anterior cruciate ligament. Coronal proton density-weighted magnetic resonance, Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate, Sagittal proton density-weighted magnetic resonance, Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased, Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate, Pre-debridement arthroscopic view showing yellowish. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. The author(s) read and approved the final manuscript. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. Postoperative recovery was four weeks on average. to 44% in the study of Cha et al. Learn how we can help 704 views Reviewed >2 years ago Thank Only nine studies met our inclusion criteria and they were all case series. Knee Surg & Relat Res 33, 26 (2021). Preoperative and postoperative results of eleven patient were compared. The patient presented with extension block of the knee. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. This site needs JavaScript to work properly. These appearances must be differentiated from mucoid degeneration of the intact ACL. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. PROSPERO. Magn Reson Imaging Clin N Am. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Accessed 1 Mar 2021. Would you like email updates of new search results? 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. The appearance can mimic acute or chronic interstitial partial tears of the ACL. MRI - Interstitial ACL tear With Mild knee joint effusion ,No evidence of discontinuation of fibre Can Interstitial ACL tear heal without surgery Asked for Male, 22 Years 78 Views v Dr. Abhishek Kaushik Joint Replacement Surgeon | Delhi 1/1 people found this helpful Hi.
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