Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. 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. 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. Unable to process the form. in 1999 [ 1 ]. 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. J Chin Med Assoc. 2011;19(3):408411. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. -. Would you like email updates of new search results? eCollection 2021. Epub 2013 Aug 27. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Mucoid degeneration of the anterior cruciate ligament. In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). 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. J Orthop. 8600 Rockville Pike Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. 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 . Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Arthroscopic treatment of mucoid degeneration of the anterior cruciate 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. Anterior cruciate ligament mucoid degeneration: selecting the best Mucoid degeneration of anterior cruciate ligament (ACL) Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Sagittal T2-weighted MRI view showing intact anterior, Fig. The aetiology of MDACL is not clearly understood. Introduction to Arthroscopic Debridement Epub 2010 May 8. 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). Management of mucoid degeneration of the anterior cruciate ligament: a Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. Arthroscopic findings. Generally, we know little about this condition. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mucoid degeneration of the anterior cruciate ligament. 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Dietary management and various treatments Scanning and diagnostic . See this image and copyright information in PMC. Case report: Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Mucoid degeneration of both ACL and PCL. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Anterior cruciate ligament mucoid degeneration: a review of the 2004;182(5):12837. https://doi.org/10.2214/ajr.182.5.1821283, Article 1). (B) Partial resection, MeSH Eight studies reported postoperative instability. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Preoperative magnetic resonance imaging (MRI), Fig. Level of Evidence: Level IV. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. All patients (100%, n=11) reported a good to very good surgery satisfaction. Federal government websites often end in .gov or .mil. The appearance can mimic acute or chronic interstitial partial tears of the ACL. It can cause pain and to a meniscal tear. 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). 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. These appearances must be differentiated from mucoid degeneration of the intact ACL. You can read more if you want. [6], in 62% of patients (18 of 29) in the study of Lintz et al. Glossary of terms for musculoskeletal radiology. 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]. Does mucoid degeneration of ACL require surgery? - TimesMojo The patient presented with extension block of the knee. Knee Surg Sports Traumatol Arthrosc. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Bethesda, MD 20894, Web Policies 2 ). Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. (2018) Radiology. 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.). https://doi.org/10.1016/j.jclinepi.2009.06.005. The .gov means its official. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. Epub 2018 Aug 22. Rehabilitation, speech therapy, crenotherapy. Careers. Careers. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. Magn Reson Imaging Clin N Am. 2007;15 (1): 73-86. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Other theories include Degenerative theory- MD could occur due to ageing.[3]. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. https://doi.org/10.1302/0301-620X.81B2.0810304, Article Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Learn how we can help 704 views Reviewed >2 years ago Thank Intact fibers are best seen on T2WI. The origin of MDACL may be degenerative or traumatic. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. 1992;159(2):35760. ACL MUCOID DEGENERATION RADIOLOGY MRI - Radedasia Seventeen females (67%) and eight males (33%) were included in the final analysis. eCollection 2022 May-Jun. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. Postoperative pain relief ranged from 53.8 to 95%. Clin Orthop Surg. This site needs JavaScript to work properly. All patients (100%, n=11) reported an improvement in pain. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. 2011. Pain was posterior in 23 knees (80%). The purpose of this study was to investigate the outcome of management of MDACL by performing a systematic review of methods of treatment that have been reported. Mucoid Degeneration of the Anterior Cruciate Ligament: A Case Report Papadopoulou P. The celery stalk sign. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. This systematic review has some limitations. J Bone Joint Surg Br. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms The .gov means its official. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Ventura et al. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and MethodsBetween December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis . Arthroscopy 24(6):642649. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). had the largest number of patients (91) with a mean age of 61 years, which was the oldest study population amongst the nine studies [16]. Bethesda, MD 20894, Web Policies proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. This makes it difficult to relate the improvement of symptoms to ACL debridement. 5. The site is secure. Introduction: Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Anatomopathology samples were collected in 18 cases. Score: 4.7/5 (45 votes) . Arthroscopic management of mucoid degeneration of anterior cru 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. Its signal is increased on all sequences. HHS Vulnerability Disclosure, Help 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). An official website of the United States government. However, the authors did not report whether there were any other patients with symptomatic instability. MRI - Interstitial ACL tear With Mild knee joint effusion ,No evidence of discontinuation of fibre Can Interstitial ACL tear heal without surgery Asked for Male, 22 Years 78 Views v Dr. Abhishek Kaushik Joint Replacement Surgeon | Delhi 1/1 people found this helpful Hi. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. 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 the ACL is suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences in MRI is identified in a patient with physically intact ligament and no obvious trauma history. sharing sensitive information, make sure youre on a federal What is myxoid degeneration treatment? 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. Knee Surg Sports Traumatol Arthrosc. Bergin et al. Morice et al. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. Part of Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. and transmitted securely. PubMed 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. Keywords: 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 . Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Knee Surgery & Related Research Unauthorized use of these marks is strictly prohibited. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Presentation Patients usually present with nonspecific posterior knee pain with restriction of flexion. Le signe de la branche de cleri - ResearchGate As there was no control group in any of the studies and the natural history of MDACL is not known, the postoperative improvement may have been attributed to the placebo effect, simultaneous arthroscopic procedures or the postoperative rehabilitation, or may be due to the pain having resolved without treatment at all. Questions just answered: mucoid degeneration of acl physiotherapy. 2023 BioMed Central Ltd unless otherwise stated. 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). This study concerns complete ACL resec Anterior Cruciate Ligament (ACL) MRI: Practice Essentials, Anatomy did not report on this. Pandey, Vivek et al. Please enable it to take advantage of the complete set of features! Conclusions: Mucoid degeneration of the ACL is a clinical condition afflicting active middle-aged people without a single significant traumatic episode with a specific MRI picture. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. The site is secure. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. What causes mucoid degeneration of ACL? Mucinous material within the substance of ACL produces pain and limited motion in the knee. 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. The mean age of patients ranged from 31 to 78years. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. 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 mean follow up ranged from 13 to 72months. Accessibility Three reviewers (an experienced librarian and two of the authors) independently searched these databases. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. Orthop Traumatol Surg Res. Roberts CC, Towers JD, Spangehl MJ et-al. Symptomatic ACL mucoid degeneration in middle-age athletes. Skeletal Radiology. 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. PubMed Background: 8600 Rockville Pike Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Reeducation. On clinical examination, the active range of motion showed a flexion deficit. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. Knee Surg Sports Traumatol Arthrosc 21(3):658663. It is a chronic degenerative change of a bulky ACL that may lead to notch impingement syndrome in the absence of instability symptoms and significant trauma history [ 1, 2, 3, 4 ]. AJR Am J Roentgenol. Anterior Cruciate Ligament (ACL) Mucoid Degeneration - Physiopedia Clin Orthop Surg 10(3):307314. Symptomatic ACL mucoid degeneration in middle-age athletes. At the time the article was last revised Dai Roberts had no recorded disclosures. Mucoid degeneration itself is described as a yellow or brown substance which can be either seen through the most anterior fibers of the ACL or found by probing between them [ 19, 35] (Fig. A total of 313 knees in 292 patients were included in the nine studies. Careers. Epub 2011 Feb 18. (100%). Anterior cruciate ligament mucoid degeneration: Selecting the best For non-comparative studies, this consists of eight questions. The https:// ensures that you are connecting to the 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. Symptomatic instability was highest in the study of Lintz et al. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. The authors declare that they have no competing interests. Cite this article. We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). 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. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). The mean MINORS score was 9.5 out of 16 (412). Privacy MAUDE Adverse Event Report: GENZYME BIOSURGERY (RIDGEFIELD) SYNVISC ONE Conclusions: There was strong association with chondral lesions and meniscal tears. Unauthorized use of these marks is strictly prohibited. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). . The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. Symptoms included limited range of motion (ROM) and posterior knee pain. Disclaimer. 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. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Mucoid Degeneration of the Anterior Cruciate Ligament - ResearchGate This was lowest in the study of Cha et al. (A) Bulging of the hypertrophied anterior cruciate ligament. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. An official website of the United States government. Patients will . Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. J Chin Med Assoc. Radiofrequency Ablation for Mucoid Degeneration of the Anterior Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. The site is secure. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. The extracted data were heterogeneous in terms of outcome assessment. Mumbai, Maharashtra, India. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. Deep Seated Pain at Back of Knee with Bending | Dr HC Chang statement and An official website of the United States government. J Bone Joint Surg Ser B 81(2):304305. 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. 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). Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Mucoid degeneration of the anterior cruciate ligament - PubMed A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. None of the studies was a randomised controlled trial and none had a control group. 2018;4(4):875-80. Mucoid degeneration of ACL Justamom21 Feb 17, 2023 7:27 AM Among other conditions - osteoarthritis, osteopenia, spondylolisthesis- an MRI report showed "severe mucoid degeneration of the ACL" in my left knee. International Journal of Orthopaedics. Cookies policy. Methods: Fig. Diffuse Intrasubstance Signal Abnormalities Ofthe Posterior Cruciate Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. MM and A performed the literature search, and data analysis. Before In the Lintz study, total resection of the ACL was performed in 17 out of 29 knees, while in the Ventura study total resection was performed in 17 out of 25 patients. There is no consensus on treatment and evidence is scarce. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. official website and that any information you provide is encrypted Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). 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). W B Saunders Co. (2005) ISBN:0721602703. Mucoid Degeneration of Posterior Cruciate Ligament with Secondary There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). I have persistent pain in the back of that knee that is exacerbated by walking and bending it. 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. ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Noninfiltrating synovial cysts of the ACL were excluded. Postoperative pain relief was reported in seven studies. Orthopaedics & Traumatology: Surgery & Research. Case report: intra-tendinous ganglion of the anterior cruciate ligament Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? 2009. J Arthrosc Joint Surg 3(1):2833.