Mumbai, Maharashtra, India. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Background: Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Arthroscopy. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 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 . The success of treatment for MDACL and the subsequent risk of instability is not known. Mucinous material within the substance of ACL produces pain and limited motion in the knee. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Orthopedics; anterior cruciate ligament; arthoscopy. -, 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. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review, https://doi.org/10.1186/s43019-021-00110-6, https://doi.org/10.1302/0301-620X.81B2.0810304, https://doi.org/10.1007/s00167-011-1433-0, https://doi.org/10.2214/ajr.182.5.1821283, https://doi.org/10.1007/s00167-012-1991-9, https://doi.org/10.1016/j.arthro.2003.11.030, https://doi.org/10.1016/j.jclinepi.2009.06.005, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782, https://doi.org/10.1046/j.1445-2197.2003.02748.x, http://journals.sagepub.com/doi/10.1177/2325967118786930, http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, https://doi.org/10.1016/j.arthro.2008.02.004, https://doi.org/10.1016/j.jajs.2015.12.001, https://doi.org/10.4055/cios.2018.10.3.307, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. The site is secure. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Skeletal Radiol. Federal government websites often end in .gov or .mil. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Bergin et al. Eight studies reported postoperative instability. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. Epub 2013 Aug 27. 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. Besides, the patient may also have trouble in moving. 4. Mucoid degeneration of ACL. The cause is not really known, but patients usually do not complain of instability. Before Bookshelf HHS Vulnerability Disclosure, Help 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. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. . Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. PubMed Central Knee Surg Sports Traumatol Arthrosc. Method. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. eCollection 2022 May-Jun. . It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. IV (retrospective cohort study). Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Characteristic: "celery stalk" appearance. Copyright 2010 Elsevier Masson SAS. In most cases Physiopedia articles are a secondary source and so should not be used as references. 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. 2013;15(1). A positive Lachman test and a negative pivot shift were noted after surgery in all cases. 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. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Bergin et al. Physical Therapy. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. 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). Bookshelf 2011. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. 2007;245 (3): 916-7. FOIA This is a rare pathological condition, in which, there is increased signal from within the ligament. eCollection 2013. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. 2011;19(3):408411. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . 1999;81(2):304305. Symptomatic ACL mucoid degeneration in middle-age athletes. 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). The site is secure. sharing sensitive information, make sure youre on a federal The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). eCollection 2022 May-Jun. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Sweed, T., Mussa, M., El-Bakoury, A. et al. [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. The mean MINORS score was 9.5 (range 412). Preoperative and postoperative results of eleven patient were compared. 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. 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. Level of Evidence: Level IV. What is myxoid degeneration treatment? Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). The .gov means its official. Postoperative pain relief was reported in seven studies. 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]. (61years), which was the largest study and represented more than one third of the total patients included in this review. PubMed 2. 2009. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Bethesda, MD 20894, Web Policies (10%) and highest in the study of Ventura et al. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. The https:// ensures that you are connecting to the Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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 ]. official website and that any information you provide is encrypted Unable to load your collection due to an error, Unable to load your delegates due to an error. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Would you like email updates of new search results? Morice et al. GG and AM interpreted the results and reviewed the manuscript. Knee Surg & Relat Res 33, 26 (2021). Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Results: Bethesda, MD 20894, Web Policies official website and that any information you provide is encrypted 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. Careers. 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 . 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. 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. Score: 4.7/5 (45 votes) . https://doi.org/10.4103/0019-5413.128765, Article Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. 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. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. ACL tears don't heal as such. Unable to load your collection due to an error, Unable to load your delegates due to an error. The clinical presentation is one of posterior pain with limited flexion. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. 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. The extracted data were assessed for meta-analysis. 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. 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. Arthroscopy. The rate of simultaneous meniscectomy ranged from 13 to 44%. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. No treatment is usually required. Seventeen females (67%) and eight males (33%) were included in the final analysis. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. What causes mucoid degeneration of ACL? Mucoid degeneration of both ACL and PCL. Unauthorized use of these marks is strictly prohibited. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. 2004;182(5):12831287. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Dietary management and various treatments Scanning and diagnostic . Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. It has recently been postulated that mucoid degeneration of the ACL is related to the medial knee compartment joint space loss in patients with osteoarthritis or in the OA risk group 6. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. 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. FOIA 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. AJR Am J Roentgenol. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Mucoid degeneration of the anterior cruciate ligament. Indian J Orthop 46(5):561565. 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). The mean age at the time of surgery was 57 years (range, 31 to 78 years). The .gov means its official. just over two decades ago [], the interest in this condition has quickly gathered pace in the orthopaedic community.Little is known about this condition that affects 1.8-5.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. 1. Discussion: ACL debridement was partial in all studies except for those by Lintz et al. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. government site. 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. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. 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). 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. Online ahead of print. Arch Orthop Trauma Surg. Instrumental treatment. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. 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. Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). Symptoms included limited range of motion (ROM) and posterior knee pain. Knee Surgery, Sports Traumatology, Arthroscopy. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Anterior knee pain is the more common complaint. HHS Vulnerability Disclosure, Help Reeducation. Arthroscopy 24(6):642649. Khanna et al. Careers. 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. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. 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. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. reported on the co-existence of mucoid degeneration and ganglia of the ACL. did not report on this. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 2012;4 (2): 167-70. Postoperative pain relief ranged from 53.8 to 95%. Arthroscopy. Knee Surg Sports Traumatol Arthrosc 21(3):658663. Mucoid degeneration of the anterior cruciate ligament. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Epub 2011 Feb 18. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. You can read more if you want. [Diagnosis and treatment of anterior cruciate ligament cysts]. PROSPERO. 6. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. Mucoid cystic degeneration of the cruciate ligament. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. PubMedGoogle Scholar. . 2001;30(6):312315. Unauthorized use of these marks is strictly prohibited. Individuals were included in the study if they had had complete MRIs of the affected knee at baseline and at 4-year follow-up, had thigh MRIs at baseline and had no additional surgery in the meantime. Pain was posterior in 23 knees (80%). MeSH Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. J Knee Surg. 2 ). We herein describe a case of PCL mucoid degeneration presented with secondary ACL . Bergin D, Morrison WB, Carrino JA et-al. Manage cookies/Do not sell my data we use in the preference centre. 287 (3): 912-921. The total number of patients with symptomatic instability was 18 out of 288 (6%). Conclusions: Before https://doi.org/10.1007/s00167-011-1433-0, Article The .gov means its official. Skelet Radiol 30(6):312315. However, symptomatic instability was not common. Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.817.97 years (42-74 years). The minimum follow-up was 3 years. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Careers. Sagittal T2-weighted MRI view showing intact anterior, Fig. Orthopaedics & Traumatology: Surgery & Research. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Federal government websites often end in .gov or .mil. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. Therefore, indications for ACL resection must be carefully selected. Epub 2008 Dec 17. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). 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). 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. 1). Accessibility Bookshelf Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. https://doi.org/10.1007/s00167-012-1991-9, McIntyre J, Moelleken S, Tirman P (2001) Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Results: This site needs JavaScript to work properly. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. All nine studies included patients with symptomatic MDACL confirmed by MRI (Table3). Knee Surg Sports Traumatol Arthrosc. In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Knee Surgery & Related Research 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). Its signal is increased on all sequences. Would you like email updates of new search results? Instrumental treatment. It may lead to knee pain. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. eCollection 2021. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid Anterior cruciate ligament mucoid degeneration. Clin Orthop Surg 10(3):307314. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. and transmitted securely. Initially, partial weightbearing is allowed. The https:// ensures that you are connecting to the Please enable it to take advantage of the complete set of features! Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. National Library of Medicine Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. Physiotherapy. mucoid degeneration of acl mri. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. 2008 Jun;24(6):642-9. doi: 10.1016/j.arthro.2008.02.004. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. Chudasama et al. The origin of MDACL may be degenerative or traumatic. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. 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). 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.