Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. This makes it difficult to relate the improvement of symptoms to ACL debridement. (A) Bulging of the hypertrophied anterior cruciate ligament. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. J Bone Joint Surg Br. have described the following MRI criteria [4]: (1) high signal intensity in the T1 and T2 sequences, (2) increased ACL volume and (3) continuous fibres of ACL shown in the T2 sequence. There is no consensus on treatment and evidence is scarce. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. Instrumental treatment. California Privacy Statement, The https:// ensures that you are connecting to the Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. . eCollection 2021. 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. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. 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. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. A total of 313 knees in 292 patients were included. Ligaments are very tough, fibrous tissue structures. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. They respond well to a judicious arthroscopic release of the ACL with notchplasty. Sweed, T., Mussa, M., El-Bakoury, A. et al. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Rehabilitation, orthophony, crenotherapy. Am J Roentgenol 182(5):12831287. FOIA Intact fibers are best seen on T2WI. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. government site. 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. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. and transmitted securely. The .gov means its official. Clin Orthop Surg. Accessibility [16]. [Diagnosis and treatment of anterior cruciate ligament cysts]. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. government site. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 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 . The rate of association between meniscal tears and MDACL ranged from 9 to 96%. The aetiology of MDACL is not clearly understood. 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. Four studies reported only postoperative scores, which were comparable to those in other studies. sharing sensitive information, make sure youre on a federal Before Orthop Traumatol Surg Res. Cho SD, Youm YS, Lee CC et-al. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. National Library of Medicine All rights reserved. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Introduction: Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. reported the largest percentage of patients (27.5%) with a positive pivot test. what causes mucoid degeneration of acl. An official website of the United States government. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Conclusions: An official website of the United States government. It is a chronic degenerative change of a bulky ACL that may lead to notch . 1. Tamer Sweed. 2 ). Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. -. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. A long duration of non-specific knee pain in a patient should be evaluated with MRI. The mean MINORS score was 9.5 out of 16 (412). Bethesda, MD 20894, Web Policies ACL tears don't heal as such. All patients (100%, n=11) reported an improvement in pain. and transmitted securely. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). 1. The success of treatment for MDACL and the subsequent risk of instability is not known. 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. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Mucoid cystic degeneration of the cruciate ligament. Arthroscopic debridement of the ACL resulted in good pain relief and improved range of movement in all studies, with postoperative improvement in the knee scores. Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. Accessibility The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Skelet Radiol 30(6):312315. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. An official website of the United States government. Unable to load your collection due to an error, Unable to load your delegates due to an error. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. 2007;90(3):1923. Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. By using this website, you agree to our Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Epub 2018 Jan 2. [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%). It results in postoperative laxity, but rarely in frank instability. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. Would you like email updates of new search results? 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. It may lead to knee pain. and transmitted securely. AJR Am J Roentgenol. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Preoperative magnetic resonance imaging (MRI) scan. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. 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. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. 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. . 2004;182 (5): 1283-7. All nine studies included patients with symptomatic MDACL confirmed by MRI (Table3). Average improvement in flexion was 21.5 degrees (0 to 60 degrees). National Library of Medicine 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. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. The mean age of patients ranged from 31 to 78years. 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 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. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 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. Keywords: Mucoid degeneration of ACL. Anterior cruciate ligament mucoid degeneration. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. 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. ACL debridement was partial in all studies except for those by Lintz et al. PMC The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. MeSH The appearance can mimic acute or chronic interstitial partial tears of the ACL. 2011. Only nine studies met our inclusion criteria and they were all case series. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. 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]. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Reeducation. The author(s) read and approved the final manuscript. 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. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Mucoid degeneration of A C L is more common and literature has also reported many cases, but for PCL only few cases have been reported in English literature. AJR Am J Roentgenol. Fig. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. Knee. 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. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Mucoid degeneration of both ACL and PCL. 2011;19(3):408411. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. in 1999 [1]. CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. 2012;4 (2): 167-70. FOIA JBR-BTR. Ventura et al. AJR Am J Roentgenol. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Bone and joint imaging. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. Arthroscopy. The ligament is mainly responsible for restraining anterior translation of knee. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Would you like email updates of new search results? (100%). Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. Open Grey database was searched for grey literature using the same keywords. 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. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Rehabilitation, speech therapy, crenotherapy. 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). Clipboard, Search History, and several other advanced features are temporarily unavailable. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Please enable it to take advantage of the complete set of features! Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. MUCOID DEGENERATION OF ACL - ARTHROSCOPIC TREATMENT 2,375 views Sep 15, 2019 23 Dislike Dr. Prateek Joshi- Ortho 1.02K subscribers Notice Age-restricted video (based on Community Guidelines). The appearance can mimic acute or chronic interstitial partial tears of the ACL. 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. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. These appearances must be differentiated from mucoid degeneration of the intact ACL. In most cases Physiopedia articles are a secondary source and so should not be used as references. Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. 8600 Rockville Pike Therefore, indications for ACL resection must be carefully selected. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first described in the literature in 1999.1 Since then, MD-ACL has been recognized as a pathology present on between 0.7% and 5.3% of magnetic resonance images performed for knee pain.2 MD-ACL is thought to be part of a spectrum of ACL disease that can range from ganglion cysts to MD.3 MD-ACL can either be primary (idiopathic . Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. All nine studies were case series; six were retrospective and three were prospective studies. Hypothesis: Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Khanna et al. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Before Imaging: Plain radiographs 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. official website and that any information you provide is encrypted ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. 287 (3): 912-921. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. ADVERTISEMENT: Supporters see fewer/no ads. 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. Chudasama CH, Chudasama VC, Prabhakar MM. 2007;15 (1): 73-86. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Unauthorized use of these marks is strictly prohibited. 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). 2011 Aug 1;19(8):1326-33. Noninfiltrating synovial cysts of the ACL were excluded. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. After the literature search and exclusion of duplicates, 54 papers were retrieved: 12 articles were assessed for eligibility, and of these, 9 papers met the inclusion criteria and were included in the systematic review [3, 6, 13,14,15,16,17,18,19] (Fig. 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. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. -, Fealy S, Kenter K, Dines JS, Warren RF. Knee Surgery, Sports Traumatology, Arthroscopy. Papadopoulou P. The celery stalk sign. Unable to load your collection due to an error, Unable to load your delegates due to an error. Symptomatic ACL mucoid degeneration in middle-age athletes. 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. 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. What you feel (symptoms) You feel heaviness in knee joint. Instrumental treatment. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management.
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