Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Partial/Total ACL resection arthroscopically- There is marked improvement in the range and reduced posterior pain, but at the cost of increased post-operative knee laxity. [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%). A total of 313 knees in 292 patients were included. It results in postoperative laxity, but rarely in frank instability. AJR Am J Roentgenol. -. 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. 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). Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. The primary intervention was arthroscopic ACL debridement in eight studies; this was combined with notchplasty in cases of impingement with the lateral wall of the notch in five studies [6, 14, 16,17,18] (Table 3). 2 ). We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). -, Makino A, Pascual-Garrido C, Rolon A, Isola M, Muscolo DL. What you feel (symptoms) You feel heaviness in knee joint. Anatomopathology samples were collected in 18 cases. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. 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 ). Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. Before Physical Therapy. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. Two patients uderwent secondary ligamentoplasty. For non-comparative studies, this consists of eight questions. It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. Therefore, indications for ACL resection must be carefully selected. We report a case of a patient with mucoid degeneration of the ACL, presenting with posterior knee pain and no history of a major knee trauma. Learn how we can help 704 views Reviewed >2 years ago Thank The knee is a complex synovial joint that can be affected by a range of pathologies: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. AJR Am J Roentgenol. 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. Bergin et al. CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. Bethesda, MD 20894, Web Policies [6], in 62% of patients (18 of 29) in the study of Lintz et al. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. Later studies reported that changes consist of mucoid Results degeneration, neovascularisation, and tendon sheath hyper- Nineteen patients met the inclusion criteria and were inclu- trophy. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Postoperative pain relief ranged from 53.8 to 95%. Noninfiltrating synovial cysts of the ACL were excluded. Truncation means that the . Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. This is a rare pathological condition, in which, there is increased signal from within the ligament. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. Arthroscopy. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. (Table 3). 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. Disclaimer. 2013;15(1). Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Categories were determined in accordance with the study of Ekhtiari et al. -, Hodler J, Haghighi P, Trudell D, Resnick D. The cruciate ligaments of the knee: Correlation between MR appearance and gross and histologic findings in cadaveric specimens. in 1999 [ 1 ]. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . We herein describe a case of PCL mucoid degeneration presented with secondary ACL . Skeletal Radiol. Method. 287 (3): 912-921. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. 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). On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. government site. The .gov means its official. Part of 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2011. Please enable it to take advantage of the complete set of features! In most cases Physiopedia articles are a secondary source and so should not be used as references. Advanced MR imaging of the cruciate ligaments. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. 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. : A Meta-Analysis. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Epub 2011 Feb 18. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. 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. 8600 Rockville Pike 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). 1992;159(2):35760. 2007;245 (3): 916-7. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Unable to process the form. J Chin Med Assoc. Careers. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Only nine studies met our inclusion criteria and they were all case series. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. Clinical outcome was reported using a variety of scores (the Lysholm and International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the visual analogue scale (VAS) score) in the different studies; these are summarized in Table 4. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Knee. In the nine included studies, four different scores were used for outcome assessment. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Online ahead of print. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. However, the authors did not report whether there were any other patients with symptomatic instability. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Intact fibers are best seen on T2WI. Arthroscopic findings. The clinical presentation is one of posterior pain with limited flexion. Mucinous material within the substance of ACL produces pain and limited motion in the knee. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. 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. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. An official website of the United States government. This site needs JavaScript to work properly. What causes mucoid degeneration of ACL? Individuals with mucoid degeneration of the ACL were excluded. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. 5. -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). 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. Check for errors and try again. The .gov means its official. https://doi.org/10.1186/s43019-021-00110-6, DOI: https://doi.org/10.1186/s43019-021-00110-6. Epub 2008 Apr 18. Chudasama et al. 2001;17(9):E37. 1 Its prevalence in magnetic resonance imaging (MRI) is 1.8-5.3%, but not all lesions are symptomatic.2, 3 It is characterized by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the This site needs JavaScript to work properly. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. 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. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Background: Ligaments hold our bones together and allow us to bend, twist, pivot and rapidly accelerate and decelerate and yet maintain the stability of our joints. Arch Orthop Trauma Surg. 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. Keywords: Anterior knee pain is the more common complaint. and Ventura et al. Score: 4.7/5 (45 votes) . GG and AM interpreted the results and reviewed the manuscript. sharing sensitive information, make sure youre on a federal Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. J Orthop. Orthopaedics & Traumatology: Surgery & Research. 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 . Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. The mean age of patients ranged from 31 to 78years. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. A total of nine studies were eligible for review. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. J Knee Surg. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Mucoid degeneration of ACL. 2011. ANZ J Surg 73(9):712716. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. Unable to load your collection due to an error, Unable to load your delegates due to an error. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. 1). Methods: Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Privacy PMC https://doi.org/10.2214/ajr.182.5.1821283, Article Clipboard, Search History, and several other advanced features are temporarily unavailable. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. (A) Bulging of the hypertrophied anterior cruciate ligament. 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]. Ligaments are very tough, fibrous tissue structures. Epub 2018 Aug 22. Arch Orthop Trauma Surg. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. National Library of Medicine 2. Unable to load your collection due to an error, Unable to load your delegates due to an error. National Library of Medicine Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee 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). A 48-year-old-male patient presented with knee pain and limitation of motion. This was lowest in the study of Cha et al. Patients and methods: Hide glossary Glossary. J Bone Joint Surg Ser B 81(2):304305. The success of treatment for MDACL and the subsequent risk of instability is not known. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. Clin Orthop Surg 10(3):307314. Arthroscopic findings. Accessibility The https:// ensures that you are connecting to the sharing sensitive information, make sure youre on a federal Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Unauthorized use of these marks is strictly prohibited. 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. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. This site needs JavaScript to work properly. Bookshelf Orthop Traumatol Surg Res 99(6):693697, Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS (2016) Mucoid degeneration of the anterior cruciate ligament: partial arthroscopic debridement and outcomes. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. official website and that any information you provide is encrypted report that one patient had ACL reconstruction simultaneously after the ACL debridement. Bookshelf 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. Preoperative magnetic resonance imaging (MRI) scan. (B) Partial resection, MeSH Therefore, indications for ACL resection must be carefully selected. J Sports Med Phys Fitness 48(4):483487, PubMed Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. Fourteen knees (48%) had limited flexion, on average 97 degrees. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. 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. MeSH Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Case report: Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. statement and 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]. Second, methodological quality assessment showed that three studies had low methodological quality. The reported restriction of range of movement was flexion deficit in four studies [3, 13, 15, 17], extension deficit in one study [14] and combined flexion and extension deficit in four studies [6, 16, 18, 19] (Table4). Download Citation | On Feb 1, 2023, O.R. The extracted data were assessed for meta-analysis. Cite this article. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. (A) Bulging of, Fig. 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. The https:// ensures that you are connecting to the ACL ganglion cyst at arthroscopy may appear as a cystic mass with . The retrospective study by Kim et al. 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). Accessed 1 Mar 2021. 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.
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