Physiotherapy. CAS Diagnosis. Knee Surgery & Related Research Imagination. At the time of the injury, a "pop" or "snap . 1st ed. Connect with thousands of patients and caregivers for support and answers. J Sports Med Phys Fit 48(4):483487, CAS (7a) Intra-articular extension of a cruciate ligament ganglion. The lesion may look like an elongated cyst along the long axis of the ACL, or as an enlarged ACL. Sagittal T1-weighted (1a) and fat-suppressed proton density-weighted (1b) images. Despite recent developments suggesting that debulking of MD-ACL does not cause instability [8], the involvement of another surgery that can directly be impacted by it complicates the decision making. PubMed Central Anterior knee pain is the more common complaint. Have your symptoms been continuous or occasional? Truncation means that the . How long does it take an ACL to heal without surgery? If your activities do not involve making pivoting movements on the knee, physical therapy rehabilitation may be all you need. PubMed Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. This study used PRP to augment the weakened ACL and followed patients for 1 year to assess outcomes. On inter-group comparison, the group in which debulking was done had better mean KSS and mean IKDC score at 2years of follow-up (p<0.05). Often these tears can occur with minimal load and trauma. Close. Indian J Orthop 46(5):561565. Justamom21. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. Mucoid degeneration of anterior cruciate ligament (ACL). It can be misdiagnosed a partial ACL tear. strings of text saved by a browser on the user's device. However, the presence of MD-ACL means the associated impingement symptoms have the propensity to continue despite the arthroplasty. https://doi.org/10.1186/s10195-020-00551-x, Mulligan EP, McGuffie DQ, Coyner K, Khazzam M (2015) The reliability and diagnostic accuracy of assessing the translation endpoint during the lachman test. But full ACL tears cannot be healed without surgery. https://doi.org/10.3109/17453679209154722, Gibson PH, Goodfellow JW (1986) Stress radiography in degenerative arthritis of the knee. [20], Chudasama etal. It is postulated that intraosseous extension may be a finding more often associated with pain (8a). The ortho I saw is a spine guy and said the knee didn't . The ACL provides approximately 85% of the total restraining force of anterior translation. To summarize, debulking of mucoid ACL in patients undergoing unicompartmental knee arthroplasty significantly reduces the rest pain and improves the final range of motion of the knee joint, subsequently improving the overall functional and clinical outcome of the patient and resulting in greater patient satisfaction. [22], Pandey etal. A painful injury where the upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues. It also prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses [1]. Therefore, indications for ACL resection must be carefully selected. > Follow SCIRP. We describe Arthroscopic near total debridement of mucoid degenerated ACL in . The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case series. I have multiple issues spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Complete your request online or contact us by phone. Modalities such as icing, joint mobilization, and massage can provide short-term pain relief and reduce swelling. Arthroscopic surgeries are key hole surgeries for joint disorders. The etiology of cruciate ligament ganglion cysts is uncertain. . [22]. The ACL can be injured or torn in a number of different ways. Ghanasingh Fine Jewels, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra, 400007, India, Galaxy Hospital, Kolar Road, Bhopal, Madhya Pradesh, 462042, India, Canadian Hospital, Abu Hail, Dubai, United Arab Emirates, You can also search for this author in Ganglion cysts are filled with gelatinous and viscous fluid in the neighbourhood of joints or tendon sheaths. Journal of the American Academy of Orthopaedic Surgeons. J Clin Med 10(2):315. https://doi.org/10.3390/jcm10020315, Article This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). This study holds clinical significance in terms of the very limited literature available on the role of MD-ACL in outcomes of patients undergoing UKA. 3 Do-Dai DD, Youngberg RA, Lanchbury FD, et al: Intraligamentous ganglion cysts of the anterior cruciate ligament: MR findings with clinical and arthroscopic correlations. Return to play following anterior cruciate ligament reconstruction. Although a few studies such as the one by Lee etal. The authors acknowledge some limitations to this study. The demographic distribution of study population with respect to the mean age, gender distribution and the side affected was similar to the recent studies done on the MD-ACL as a standalone entity [2, 3, 5, 8]. It is characterised by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the substance of ACL leading to thickening of the native ACL and its impingement on the lateral femoral condyle, femoral notch and PCL, consequently causing knee pain and limited motion. Diagnosis is usually made on the MRI. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. . A steeper PTS angle, decreased notch width index, and transverse notch angle are significantly associated with the presence of mucoid degeneration of the anterior cruciate ligament in symptomatic MD-ACL patients. However, upon following-up with these patients, and gauging their clinical and functional parameters, complaints of rest pain and restriction of terminal flexion seemed to persist. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. This site complies with the HONcode standard for trustworthy health information: verify here. 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. Anterior cruciate ligament injury. Breast cancer is one of the most common cancers in women, with more than 2 million new diagnoses last year alone. Another theory states that it is a consequence of herniation of a synovial pouch in the substance of the anterior cruciate ligament (ACL), and the subsequent synovial filling inside it; however, the major aetiology of MD-ACL still remains an enigma [4]. A longer recovery period may reduce the risk of re-injury. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Anterior cruciate ganglion cysts are probably more prevalent than stated in the literature. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p<0.05) as compared with their counterparts. 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. b Immediate post-operative radiograph showing no posterior translation of femur compared with pre-operative radiograph. Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament Clinics in Orthopedic Surgery Vol. https://doi.org/10.1007/s00167-012-1991-9, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. et al. Without adequate and timely treatment, . It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. Discrete intraosseous ganglia are observed in 3/4 of the cases with mucoid degeneration of the ACL. During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon tissue similar to a ligament that connects muscle to bone. Anterior and posterior cruciate ligament ganglion cysts are reported in the literature as being rare with an incidence of approximately 0.5% to 1%.1,2 However, in our experience, this entity is encountered more commonly, most often within the anterior cruciate ligament. The severity of the ACL injury is graded from 1 to 3. Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. : tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. Such meniscal tears are not appropriate for repair most of the time (Fig. This replacement tissue is called a graft. They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. Two characteristic MR appearances have been described for ganglion cysts of the ACL. Mayo Clinic, Rochester, Minn. Nov. 24, 2018. Various techniques have been proposed for the debulking of MD-ACL including arthroscopic debridement using shaver or radiofrequency ablation, with or without notchplasty, that have shown to give good clinical results [8, 19]. was responsible for physiotherapy, writing review, editing and project administration. Common wrist ganglions include: dorsal wrist ganglion volar wrist ganglion volar retinaculum ganglion extensor retinaculum ganglion occult ganglion intraosseous ganglion mucous cyst In a 2007 study of patients in Glasgow whose foot lumps were removed surgically, 39 of 101 cases were ganglion cysts. I get PT and acupuncture, have had several epidural injections, and am trying hard to avoid osteoporosis meds (was on bisphosphonates for many years many years ago) as well as spinal fusion. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. Instrumental treatment. strings of text saved by a browser on the user's device. (Table 2). Informed written consent was obtained from all individual participants included in the study. Google Scholar, Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D (2011) Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. An ACL sprain is when the ACL is overstretched (but not torn). The ACL graft (arrow) is abnormally lax and demonstrates abnormally increased signal intensity, likely secondary to degeneration from chronic mechanical stress. Knee Surg Sports Traumatol Arthrosc 21(3):658663. Knee Surg & Relat Res 34, 40 (2022). They were however, supplemented by other objective methods such as comparison of pre-operative, post-operative and follow-up status of lateral view of plain radiograph in standing position, to look for any posterior translation of the femur which would suggest instability. [5]. CAS The position of the femoral tunnel is important in graft isometry, permitting constant tension of the graft throughout the range of motion of the knee. Mucoid degeneration and ganglion cyst are two distinct non-traumatic lesions of the anterior cruciate ligament (ACL) that most commonly occur discretely but occasionally coexist. Reactive marrow edema (arrowheads) surrounds the intraosseous ganglia. [] found the incidence of mucoid degeneration in their study population to be 1.0%.Most of their reported cases were incidental findings without contributory symptoms. The results found improved functional scores and pain scores compared with preoperative levels. The samples collected from the five hospitals were 122 (group A: 58; group B: 64), 68 (group A: 35; group B: 33), 94 (group A: 46; group B: 48), 83 (group A: 41; group B: 42) and 75 (group A: 36; group B: 39), respectively. Intraosseous increased signal is present within the tibial spine deep to the posterior extent of the ACL insertion (arrowhead). Anterior Cruciate Ligament, is an important structure of the knee joint. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. [4]showed high percentages of laxity post debulking of MD-ACL, a finding which would not allow a surgeon to carry out a UKA after the debulking. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Contact us. No writing assistance was utilized in the production of this manuscript. Once considered a rare disease, it is probably a less diagnosed condition of knee pain. Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. Acta Orthop Scand 63(5):497501. 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 ). The anterior cruciate ligament (ACL) is a key structure in the knee joint kinematics, as it resists anterior tibial translation and rotational loads. 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. Subsequently, from January 2019, the surgeons started debulking the MD-ACL. Despite maximising the factors involved between the two groups, as the sample size collection was done during two separate time periods and consecutive sampling was done instead of randomisation, there is a possibility of sampling bias. After collecting their demographic details, the ROM of the affected knee was noted, following which they were planned for surgery in the form of mobile-bearing UKA. CAS Depending on the severity of your injury, you may be referred to a doctor specializing in sports medicine or a specialist in bone and joint surgery (orthopedic surgeon). On inter-group comparison, VAS score for rest pain of the debulking group (0.130.46) was also found to be lower than the non-debulking group (2.640.95) (p<0.05). (3a) A proton density-weighted sagittal image at the same level demonstrates increased signal within the enlarged anterior cruciate ligament (arrows) with faintly identified ACL fibers. 1 Brown MF, Dandy DJ: Intra-articular ganglia in the knee. PubMed Central Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. ), or their login data. Most surgeons recommend a program of physical therapy post-operatively to reduce pain and swelling, promote full range-of-motion, and improve knee function. An anterior cruciate ligament (ACL) mucoid degeneration, along with tears and anterior cruciate ligament ganglion cysts, is a relatively common cause of incr. Feb 17, 2023 7:27 AM. The demographic data of the study population is presented in Table 1. Clin Radiol. Int J Sports Phys Ther 10(1):5261, PubMed The rest of the surgery remained the same and all patients underwent mobile-bearing Oxford UKA. Indian J Orthop 48(2):197202. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. in this condition your acl (anterior cruciate ligament) filled with jelly like material and it thickened so space in intercondylar resion of knee joint is reduced. Functional assessment was done by the same clinician using patient-related outcome measures (PROMs) using the self-questionnaire-based International Knee Documentation Committee (IKDC) score, Knee Society score (KSS), VAS score (for rest pain) and subjective satisfaction level. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. . https://doi.org/10.1177/03635465010290051301, Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. The end point was ascertained to be when the surgeon could pass a hook between the medial cortex of the lateral femoral condyle and the lateral border of the remaining ACL. Histopathological confirmation of mucoid degeneration was obtained in all 442 patients. Instrumental treatment. Papers of special note have been highlighted as: of interest. The anterior cruciate ligament (ACL) is an important ligament in the knee. Despite integrity and status of cruciates being paramount in a UKA, no study has evaluated the effect of debulking MD-ACL in this procedure. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar etal. 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. The ligament can also tear due to work injuries or automobile accidents. On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. It provides objective end points for open debulking of mucoid ACL in these patients and, being a multicentric study, it entails external validity of this procedure in a diverse population. He did total knee replacement on both side and now my mother is walking without aid. 2nd ed. They offer less hospital stay and speedy recovery. Corroborating these findings were the improvements and the final PROMs of both the groups which corresponded with the findings of the literature review by Sweed etal. Provided by the Springer Nature SharedIt content-sharing initiative. Grade 1: The ligament is intact, and the joint is stable, but there is minimal stretching and some microscopic tearing of the ACL. anterior cruciate ligament mucoid degeneration; mucoid degeneration of the triangular . Cookies policy. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. The stability measurements were subjective, and although undertaken by a blinded clinician, could be susceptible to human error. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. ), or their login data. Pre-operative and follow-up lateral radiographs of the patients who underwent debulking were analysed by a blinded radiologist and no posterior translation of the femur was noted, thereby confirming no instability caused by the debulking (Fig. Stability of the joint is not compromised on controlled debulking. These findings were in line with the findings published by Cha etal. It can be misdiagnosed a partial ACL tear. The cause is not really known, but patients usually do not complain of instability. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Setback to comeback: Twin sisters return to the basketball court after ACL tears, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, NSF Certified for Sport Nutritional Supplements. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. . was the primary surgeon and was responsible for the conceptualization, methodology, supervision, writing review and editing. (8a) Intraosseous extension of an ACL ganglion. mucoid degeneration of acl mri. Methodology: Five patients who were diagnosed as a case . -Evaluated and planned treatment protocol in accordance with physician. An interesting feature of cruciate ganglia, which has not been widely reported, is their tendency to extend into adjacent intra-articular spaces and osseous structures. Interested in more discussions like this? Secondly, all the patients underwent the surgery and postoperative rehabilitation based on a standardized protocol which may limit the reproducibility of results if not adhered to. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. Physical therapy typically begins 7-10 days after the procedure. These include pristine lateral and patellofemoral compartments, correctable varus deformity, less than 1015 of fixed flexion deformity, flexion of more than 100, and functionally intact collateral ligaments and cruciates [10,11,12,13,14,15]. Notchplasty is an ancillary surgical procedure that consists of reshaping and widening of the intercondylar femoral notch, historically developed and performed with the aim to avoid ACL graft impingement and improve visualization of the lateral wall of the femoral notch during ACLR surgery. Without a properly functioning ACL, the other structures of the knee experience greater strain, which causes further injuries to tissues in the knee. Reeducation. The power of the study for the corrected model was estimated to be 92% for the aforementioned sample size when keeping the value of as 0.05, the degree of freedom (df) as 1, and adjusted R2 as 0.023. 2022 - 2023 Times Mojo - All Rights Reserved fatty degeneration deposit of fat globules in a tissue. All rights reserved. Hence, the improvement in ROM, attenuation of rest pain and better long term functional outcome measures supported the hypothesis regarding the positive effect of debulking a MD-ACL in patients undergoing UKA. 1998-2023 Mayo Foundation for Medical Education and Research. A physical therapist will teach you exercises that you will perform either with continued supervision or at home. 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 cruciate ligament, improving patient satisfaction and function without causing clinical instability in daily activities. (wikipedia.org)Rarely, intraosseous ganglion cysts occur, sometimes in . When considering a UKA in such a patient, a plethora of dilemmas may arise in the mind of an orthopaedic surgeon vis a vis preserving the MD-ACL at the cost of functional limitation, or debulking it and predisposing the UKA to failure owing to instability. Accumulation of mucopolysaccharides at the meniscal interstitial area disrupts the collagen network and weakens the meniscus. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. The scores were then compiled and statistically analysed using SPSS-24 software to understand if the debulking resulted in any significant difference in the outcomes. Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. Wilcoxon signed rank test was used for longitudinal intra-group comparison of ROM and PROMs between pre-operative and follow-up scores, whereas Mann Whitney U test was used to compare ROM and PROMs between the two groups at 2years follow-up. It can be secondary to trauma, or simply degeneration caused by meniscal injury, osteoarthritis or chondral damage [2]. Background: The anterior cruciate ligament (ACL) is the most commonly operated ligament of the knee. Treatment is only required if there are otherwise unexplained symptoms. Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. INTRODUCTION 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 . This content does not have an Arabic version. The median age of the affected population is estimated to be 51years [5]. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. Grade 1A laxity on Lachmans test (less than 5mm translation with a firm end-point) was noted in 27 knees (11.95%) intra-operatively in group B or those who underwent debulking (nb=226), whereas a firm endpoint with no translation was noted in all of the remaining 199 knees (88.05%). Google Scholar, White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. Informed written consent was obtained from all patients. https://doi.org/10.1016/j.knee.2020.06.004, Article Finally, the patients who underwent debulking had a better mean subjective patient satisfaction (9.830.37 versus 8.680.71) at the final follow-up at 2years (p<0.05) (Table 2). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008 (5). On exposure of the joint, ACL was looked for in terms of integrity and any degenerative changes. All the patients were operated on in a leg hanging position and under tourniquet control. The time it takes to recover is approximately 3 months. Surgery is typically not needed. A case of mucoid degeneration of the anterior cruciate ligament (ACL) is reported based on specific imaging features on MRI. What is your diagnosis? The follow-up period was similar to that of Cha etal. If left untreated, a small ACL tear will increase in size, causing more pain and increasing the laxity in the knee. 3). The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. Am J Sports Med 29(5):600613. Mayo Clinic is a not-for-profit organization. Pristine condition of the lateral compartment and not more than grade II in the patellofemoral compartment (Ahlbck classification) was confirmed in all cases. The purpose of this study was to diagnose mucoid degeneration of ACL and to assess the effectiveness of arthroscopic treatment in these patients. A common sports injury whichusually happens over time from normal wear and tear ofmuscles and tendons. On longitudinal, intra-group comparison of the individual groups, it was noted that there was statistically significant (p<0.05) improvement in the ROM of patients who underwent debulking (Z-value: 13.047; p-value: 0.00) as well as no debulking group (Z-value: 9.990; p-value: 0.00) at 2years follow-up, compared with their individual pre-operative ROM. Accessed Nov. 21, 2018. Is this likely to cause my knee pain or can it be the compressed lumbar nerve or both? What is mucoid degeneration of the meniscus? Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity with disputed theories of origin [1,2,3,4]. Correlation with operation methods in 200 knees. Its function is to stabilize the knee while bending and rotating; the ACL also keeps the knee from shifting out of place or moving anteriorly (toward the front) with pivoting activities. Methodology: Five patients who were diagnosed as a case of mucoid degeneration of the ACL based on MRI, over a period of 1 year (December 20182019), were included in the study. Unicompartmental knee arthroplasty (UKA) has rapidly emerged as a superior surgical option to total knee arthroplasty for bone-on-bone osteoarthritis owing to less trauma to the surrounding soft tissue, more conservative bone cuts, minimal bleeding, smaller incision, a better range of motion (ROM), faster recovery, preserved kinematics, higher rate of implant survival and decreased chances of major complications such as thromboembolism, cardiac arrest and stroke [9]. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. https://link.springer.com/10.1007/s00590-021-03198-4. [21] and Ventura etal. In patients undergoing UKA and diagnosed with mucoid degeneration of the ACL, controlled debulking of the ACL provides better functional outcomes as compared with non-debulking of the mucoid ACL. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors.
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