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). J Bone Joint Surg Br. The https:// ensures that you are connecting to the Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. 2004;182(5):12837. There was strong association with chondral lesions and meniscal tears. The site is secure. Accessibility Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Physiotherapy. Unable to load your collection due to an error, Unable to load your delegates due to an error. Postoperative recovery was four weeks on average. Cite this article. This was lowest in the study of Cha et al. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. . Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. and Ventura et al. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first described in the literature in 1999.1 Since then, MD-ACL has been recognized as a pathology present on between 0.7% and 5.3% of magnetic resonance images performed for knee pain.2 MD-ACL is thought to be part of a spectrum of ACL disease that can range from ganglion cysts to MD.3 MD-ACL can either be primary (idiopathic . Chudasama et al. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. 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. Mucoid degeneration of the anterior cruciate ligament. 287 (3): 912-921. 2011 Aug 1;19(8):1326-33. . 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. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. J Bone Joint Surg Ser B 81(2):304305. PubMedGoogle Scholar. MeSH Clipboard, Search History, and several other advanced features are temporarily unavailable. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. The minimum follow-up was 3 years. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. 8600 Rockville Pike Conclusion: Treatment of ACL mucoid degeneration by this modality is effective in preventing recurrence, post-operative laxity and provides better functional outcome compared to the classical partial resection of the degenerated ACL. The pathogenesis remains controversial. https://doi.org/10.1016/j.jajs.2015.12.001, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J (2018) Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. National Library of Medicine A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. in 1999 [ 1 ]. Arthroscopic debridement may help relieve the anterior knee pain. Mucoid change or mucoid degeneration refers to the irreversible tissue degeneration due to the accumulation of mucin within the fibers of tendons, ligaments, and fibrocartilage. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. No treatment is usually required. Indian J Orthop 46(5):561565. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. 2008 Jun;24(6):642-9. doi: 10.1016/j.arthro.2008.02.004. 1173185. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. 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. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. None of the studies was a randomised controlled trial and none had a control group. A total of 313 knees in 292 patients were included in the nine studies. 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 anterior cruciate ligament (ACL). Knee Surg Sports Traumatol Arthrosc. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. AJR Am J Roentgenol. Reeducation. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. The ligament is mainly responsible for restraining anterior translation of knee. 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). The aim of this study was to detail the clinical, radiological, arthroscopic, and pathological findings of mucoid degeneration of the anterior cruciate ligament and report the clinical outcomes following arthroscopic treatment. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Categories were determined in accordance with the study of Ekhtiari et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. What is Anterior Cruciate Ligament Mucoid Degeneration? and transmitted securely. https://doi.org/10.4103/0019-5413.101037, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligament management and functional outcome of 18 cases. (100%). We herein describe a case of PCL mucoid degeneration presented with secondary ACL . What Is Mucoid Degeneration of the ACL? By using this website, you agree to our For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. 2011;19(3):408411. Case report: 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. Mumbai, Maharashtra, India. Clin Orthop Surg. . Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. 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. . 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. For non-comparative studies, this consists of eight questions. Unable to load your collection due to an error, Unable to load your delegates due to an error. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. The mean MINORS score was 9.5 out of 16 (412). What causes mucoid degeneration of ACL? This site needs JavaScript to work properly. official website and that any information you provide is encrypted MM and A performed the literature search, and data analysis. Risk factors Predisposing factors include the following 1: aging 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. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. https://doi.org/10.1302/0301-620X.81B2.0810304, Article That is usually the journal article where the information was first stated. J Arthrosc Joint Surg 3(1):2833. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). National Library of Medicine Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. Bone and joint imaging. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. Pandey, Vivek et al. 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). 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. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. In most cases Physiopedia articles are a secondary source and so should not be used as references. Resnick D, Kransdorf MJ. What is myxoid degeneration treatment? No reconstruction was performed at the same time. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Epub 2010 May 8. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. volume33, Articlenumber:26 (2021) The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-3615, Case 11: with Hoffa fat pad ganglion cyst, Case 12: tibial nerve schwannoma and ACL mucoid degeneration, Case 1: Complete ACL tear and meniscal tears, Case 2: Anomalous insertion of the medial meniscus, View Frank Gaillard's current disclosures, see full revision history and disclosures, anterior cruciate ligament ganglion cysts, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Mucoid degeneration of the anterior cruciate ligament, congenital or acquired synovial tissue entrapment between ACL fibers. Keywords: The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. Second, methodological quality assessment showed that three studies had low methodological quality. what causes mucoid degeneration of acl. (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). 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. 2 ). Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. The aetiology of MDACL is not clearly understood. It results in postoperative laxity, but rarely in frank instability. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. Indian J Orthop 48(2):197202. It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. This may support the theory that it is a degenerative process. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. 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. The .gov means its official. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Knee Surgery & Related Research Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. official website and that any information you provide is encrypted This is basically an MRI diagnosis of expansion and increased signal of an intact ACL in a person with knee pain which is worse on knee flexion/bending. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Would you like email updates of new search results? Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine (2018) Radiology. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Initially, partial weightbearing is allowed. -. Would you like email updates of new search results? The clinical presentation is one of posterior pain with limited flexion. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Federal government websites often end in .gov or .mil. 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]. Download Citation | On Feb 1, 2023, O.R. Signal intensity of the anteromedial bundle (AMB) or posterolateral bundle (PLB) graft standardized to the intensity of the PCL was defined as signal intensity ratio (SIR). Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. 3. Disclaimer. See this image and copyright information in PMC. Roberts CC, Towers JD, Spangehl MJ et-al. Knee Surg Sports Traumatol Arthrosc. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and MethodsBetween December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis . 2011 Mar;25(3):262-5. A long duration of non-specific knee pain in a patient should be evaluated with MRI. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. The author(s) read and approved the final manuscript. Instrumental treatment. (Table 3). Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint and if this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings. (A) Bulging of, Fig. 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. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. had the largest number of patients (91) with a mean age of 61 years, which was the oldest study population amongst the nine studies [16]. This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. Epub 2013 Aug 27. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Knee Surg Sports Traumatol Arthrosc. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain.
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