Clin Orthop Surg. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. J Arthrosc Joint Surg 3(1):2833. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. The appearance can mimic acute or chronic interstitial partial tears of the ACL. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. The .gov means its official. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. 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 commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. At the time the article was created Frank Gaillard had no recorded disclosures. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). [16]. Mucoid degeneration of both ACL and PCL. ANZ J Surg 73(9):712716. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Bethesda, MD 20894, Web Policies 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Physiotherapy. Orthopaedics & Traumatology: Surgery & Research. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. mucoid degeneration acl symptoms. ACL tears don't heal as such. Arthroscopic findings. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. The .gov means its official. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. The site is secure. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Average patient age was 49 (22 to 68) years. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Anterior Cruciate Ligament, is an important structure of the knee joint. Epub 2021 Mar 8. reported the largest percentage of patients (27.5%) with a positive pivot test. 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. Preoperative magnetic resonance imaging (MRI) scan. It is a chronic degenerative change of a bulky ACL that may lead to notch . 2 ). Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. The extracted data were assessed for meta-analysis. 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. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. 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. Anatomopathology samples were collected in 18 cases. Other theories include Degenerative theory- MD could occur due to ageing.[3]. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. 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. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. AJR Am J Roentgenol. (B) Partial resection, MeSH http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782. Skelet Radiol 30(6):312315. mucoid degeneration of acl mri. 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). 2010 Jun 1;96(4):400-6. Khanna et al. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. These appearances must be differentiated from mucoid degeneration of the intact ACL. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Mucoid degeneration of the anterior cruciate ligament. 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. 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 . They respond well to a judicious arthroscopic release of the ACL with notchplasty. 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). This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. International Journal of Orthopaedics. Int J Curr Res Aca Rev 4(11):1824 http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI (2008) Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Before 4. Bookshelf 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Orthopedics; anterior cruciate ligament; arthoscopy. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. By using this website, you agree to our Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine Chudasama CH, Chudasama VC, Prabhakar MM. 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. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. Physiotherapy. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. 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. Mucoid degeneration of the anterior cruciate ligament. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. Anterior cruciate ligament mucoid degeneration. [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%). Cookies policy. 2011. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. Sep 2017 - Feb 20186 months. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. 2021 Sep;50(9):1837-1843. doi: 10.1007/s00256-021-03750-7. Terms and Conditions, 2. Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). 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. 287 (3): 912-921. Preoperative and postoperative results of eleven patient were compared. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. in 1999 [1]. (Table 3). Orthop Traumatol Surg Res. Methods: The minimum follow-up was 3 years. Intact fibers are best seen on T2WI. Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. 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. Arch Orthop Trauma Surg. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. Disclaimer. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. This systematic review has some limitations. Epub 2011 Feb 18. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Mucoid degeneration of the anterior cruciate ligament. (10%) and highest in the study of Ventura et al. PMC A long duration of non-specific knee pain in a patient should be evaluated with MRI. Truncation means that the . The appearance can mimic acute or chronic interstitial partial tears of the ACL. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. California Privacy Statement, All patients (100%, n=11) reported a good to very good surgery satisfaction. Disclaimer. W B Saunders Co. (2005) ISBN:0721602703. Four studies reported only postoperative scores, which were comparable to those in other studies. 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. Conclusions: Careers. Epub 2018 Apr 21. Questions just answered: mucoid degeneration of acl physiotherapy. . Learn how we can help 704 views Reviewed >2 years ago Thank Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. 2001;30(6):312315. Symptomatic ACL mucoid degeneration in middle-age athletes. Arthroscopy. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . The need for simultaneous or delayed ACL reconstruction should be discussed with patients in case total resection of the ACL is to be performed, particularly in young active patients. 2012;4 (2): 167-70. 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. Before Arch Orthop Trauma Surg. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). (2018) Radiology. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. Privacy [17] do not mention whether any patients underwent biopsy (Table 3). 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 clinical presentation is one of posterior pain with limited flexion. Provided by the Springer Nature SharedIt content-sharing initiative. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. and transmitted securely. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. This study concerns complete ACL resec The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. Bethesda, MD 20894, Web Policies The patient presented with extension block of the knee. This may support the theory that it is a degenerative process. 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). Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. It results in postoperative laxity, but rarely in frank instability. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. Federal government websites often end in .gov or .mil. 2007;15 (1): 73-86. Patients will . Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. 8600 Rockville Pike https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. 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). HHS Vulnerability Disclosure, Help Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. Unauthorized use of these marks is strictly prohibited. However, the authors did not report whether there were any other patients with symptomatic instability. "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Besides, the patient may also have trouble in moving. Level of Evidence: Level IV. official website and that any information you provide is encrypted Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. Mumbai, Maharashtra, India. What is Anterior Cruciate Ligament Mucoid Degeneration? All nine studies assessed the outcome of arthroscopic debridement of MDACL. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. This ranged from 90 to 95% in all studies, except in the report by Kim et al., where only 53.8% of patients (57/106) had complete pain relief after surgery. Characteristic: "celery stalk" appearance. 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. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Second, methodological quality assessment showed that three studies had low methodological quality. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. 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. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. Clin Orthop Surg 10(3):307314. 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. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. The mean age at the time of surgery was 57 years (range, 31 to 78 years). Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). (61years), which was the largest study and represented more than one third of the total patients included in this review. 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]. Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population-A 2-Year Follow-up Study. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. Mucinous material within the substance of ACL produces pain and limited motion in the knee. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. government site. 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 Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 8600 Rockville Pike 1173185. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. The quality of methodology was excellent in one study, good in five studies, low in two studies and very low in one study (Tables 1 and 2). sharing sensitive information, make sure youre on a federal Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. HHS Vulnerability Disclosure, Help For non-comparative studies, this consists of eight questions. Conclusion: Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . There was more than 20% loss to follow up in the study of Kim et al., while the three prospective studies had no loss to follow up [13, 14, 18]. Anterior knee pain is the more common complaint. Each study was scored 02 on each question, with a global ideal score of 16. 2011 Aug 1;19(8):1326-33. Any discrepancy was resolved by the senior author. official website and that any information you provide is encrypted Bookshelf Accessibility When refering to evidence in academic writing, you should always try to reference the primary (original) source. in 1999 [ 1 ]. It may lead to knee pain. J Clin Epidemiol 62(10):10061012. Bone and joint imaging. volume33, Articlenumber:26 (2021) . 2007;245 (3): 916-7. Mucoid degeneration of the anterior cruciate ligament: a case report. Postoperative clinical laxity was common, however, symptomatic instability was not. [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. See this image and copyright information in PMC. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. michigan obituaries 2022, tennessee highway patrol rank structure,
2022-07-08T15:03:45+08:007月 8, 2022|