Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. CAS In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Bethesda, MD 20894, Web Policies MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. Level of Evidence: Level IV. Careers. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782. Along with that, it also controls the internal rotation. Careers. PubMed Central -Evaluated and planned treatment protocol in accordance with physician. Background: The minimum follow-up was 3 years. It results in postoperative laxity, but rarely in frank instability. 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. Skeletal Radiology. . For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. 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). FOIA Individuals with mucoid degeneration of the ACL were excluded. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. https://doi.org/10.4103/0019-5413.128765, Article FOIA The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. PMC Advanced MR imaging of the cruciate ligaments. AJR Am J Roentgenol. Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Multiple theories have been put forth that explains the pathological disorganization in the collagen fibers of the Anterior Cruciate Ligament, such as synovial, traumatic, and degenerative, "Synovial theory- states that there is accumulation of synovial fluid inside the substance of ACL in a herniated pouch of synovium. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Seventeen females (67%) and eight males (33%) were included in the final analysis. Federal government websites often end in .gov or .mil. 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). There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Physical Therapy. The author(s) read and approved the final manuscript. sharing sensitive information, make sure youre on a federal and transmitted securely. 2004;182 (5): 1283-7. Results: Orthop Traumatol Surg Res. just over two decades ago [], the interest in this condition has quickly gathered pace in the orthopaedic community.Little is known about this condition that affects 1.8-5.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. Federal government websites often end in .gov or .mil. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Bergin et al. Postoperative pain relief was reported in seven studies. Pan African Medical Journal. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. The authors declare that they have no competing interests. sharing sensitive information, make sure youre on a federal No reconstruction was performed at the same time. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Clipboard, Search History, and several other advanced features are temporarily unavailable. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. At the time the article was last revised Dai Roberts had no recorded disclosures. The extracted data were heterogeneous in terms of outcome assessment. Indian J Orthop. Postoperative pain relief ranged from 53.8 to 95%. National Library of Medicine Arthroscopy. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Accessibility Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Orthopedics; anterior cruciate ligament; arthoscopy. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. 2004;182(5):12837. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Patients will . Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Epub 2011 Feb 18. PubMed Mucoid cystic degeneration of the cruciate ligament. 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. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. [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%). 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. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Conclusions. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. 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. Knee Surg Sports Traumatol Arthrosc 21(3):658663. Knee Surg Sports Traumatol Arthrosc. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. official website and that any information you provide is encrypted Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. The mean MINORS score was 9.5 (range 412). These appearances must be differentiated from mucoid degeneration of the intact ACL. Arthroscopy. All patients (100%, n=11) reported a good to very good surgery satisfaction. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. 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 . Download Citation | On Feb 1, 2023, O.R. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. The mean age of patients ranged from 31 to 78years. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Eight studies reported postoperative instability. Characteristic: "celery stalk" appearance. It has recently been postulated that mucoid degeneration of the ACL is related to the medial knee compartment joint space loss in patients with osteoarthritis or in the OA risk group 6. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. eCollection 2021. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. (100%). Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. A long duration of non-specific knee pain in a patient should be evaluated with MRI. government site. Knee Surg Sports Traumatol Arthrosc. Postoperative symptomatic instability was not common in eight studies, but was observed in 48% of patients in the study of Lintz et al., with two patients having a delayed ACL reconstruction. Manage cookies/Do not sell my data we use in the preference centre. 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. Bookshelf 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.). This site needs JavaScript to work properly. Careers. Careers. . Arthroscopy. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Please enable it to take advantage of the complete set of features! 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. 2 ). The extracted data were assessed for meta-analysis. Disclaimer. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. Dietary management and various treatments Scanning and diagnostic . Risk factors Predisposing factors include the following 1: aging By using this website, you agree to our https://www.physio-pedia.com/index.php?title=Anterior_Cruciate_Ligament_(ACL)_Mucoid_Degeneration&oldid=253974, Difficulty in climbing stairs, cross-leg sitting, squatting, Primary condition- Osteoarthritis, degenerative menisci, meniscal tear, Impingement of the soft tissue in the vicinity. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. Mucoid degeneration of the anterior cruciate ligament. Mucoid degeneration of ACL is a disease affecting ACL in which mucoid like substance (glycosaminoglycans) gets interspersed within the substance of ACL and as a result ACL gets thickened. 2010 Jun 1;96(4):400-6. and transmitted securely. Bone and joint imaging. https://doi.org/10.1016/j.arthro.2008.02.004, Morice A, Coupry A, Lintz F, Robert H (2013) Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Disclaimer. Preoperative magnetic resonance imaging (MRI), Fig. An official website of the United States government. Federal government websites often end in .gov or .mil. Keywords: Arthroscopic management of mucoid degeneration of anterior cruciate ligament. The .gov means its official. Epub 2013 Aug 27. However, MDACL is asymptomatic in most patients. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). eCollection 2022 May-Jun. JBR-BTR. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . official website and that any information you provide is encrypted This bicentric, retrospective cohort study with an average follow-up of 6years involved 27 patients (29 knees) presenting with symptomatic ACL mucoid degeneration validated by magnetic resonance imaging (MRI). Skeletal Radiol. When refering to evidence in academic writing, you should always try to reference the primary (original) source. https://doi.org/10.1302/0301-620X.81B2.0810304, Article . Discussion: Introduction: Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. 2013;15(1). 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. J Bone Joint Surg Ser B 81(2):304305. 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. https://doi.org/10.2214/ajr.182.5.1821283, Article in 1999 [1]. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. in 1999 [ 1 ]. All nine studies were case series; six were retrospective and three were prospective studies. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. and transmitted securely. Meniscectomy was undertaken in 11 cases (41%). Patients and methods: Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. eCollection 2022 May-Jun. 2. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Mucoid degeneration of the anterior cruciate ligament. 2018. http://journals.sagepub.com/doi/10.1177/2325967118786930, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. National Library of Medicine Morice et al. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Orthop Traumatol Surg Res 96(4):400406, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. See this image and copyright information in PMC. Any discrepancy was resolved by the senior author. The mean follow up ranged from 13 to 72months. Before Bookshelf J Orthop. FOIA ACL debridement was partial in all studies except for those by Lintz 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. official website and that any information you provide is encrypted Knee Surgery & Related Research MeSH Accessibility Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. statement and In six of the nine studies [6, 14, 16,17,18], arthroscopic debridement of the ACL was associated with simultaneous partial meniscectomy; this ranged from 13% in the study of Morice et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. reported the largest percentage of patients (27.5%) with a positive pivot test. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. There was strong association between degenerative changes and MDACL (82% having chondral and 69% meniscal lesions), which might suggest that MDACL is a degenerative process. Epub 2010 May 8. 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 acl mri. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. 3. 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. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. That is usually the journal article where the information was first stated. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Average patient age was 49 (22 to 68) years. Epub 2018 Aug 22. Patient having mucoid degeneration of ACL seeks multiple orthopedic consultation and most of the time treating orthopedican miss its diagnosis either because of lack of experience or rare cause of pain unless doctor sought magnetic resonance imaging (MRI) of knee. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. 2018;4(4):875-80. Orthop Traumatol Surg Res. Provided by the Springer Nature SharedIt content-sharing initiative. . Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. They respond well to a judicious arthroscopic release of the ACL with notchplasty. The https:// ensures that you are connecting to the The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Mucoid degeneration of the anterior cruciate ligament (ACL) is regarded as a degenerative change in the ligament, which is clinically presented with pain on full extension or flexion in the middle-aged population. 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. Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon non-traumatic cause of knee pain and motion restriction, typically seen in a middle-aged population. However, symptomatic instability was not common. [Diagnosis and treatment of anterior cruciate ligament cysts]. The cause is not really known, but patients usually do not complain of instability. https://doi.org/10.1186/s43019-021-00110-6, DOI: https://doi.org/10.1186/s43019-021-00110-6. : A Meta-Analysis. 2021 Sep;50(9):1837-1843. doi: 10.1007/s00256-021-03750-7. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty.