[Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). The mean follow up ranged from 13 to 72months. 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. 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. National Library of Medicine Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. The pathogenesis remains controversial. Epub 2011 Feb 18. CAS This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. National Library of Medicine Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Four studies reported only postoperative scores, which were comparable to those in other studies. The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. . Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Knee Surg & Relat Res 33, 26 (2021). Clin Orthop Surg. California Privacy Statement, Postoperative pain relief ranged from 53.8 to 95%. J Knee Surg. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. However, MDACL is asymptomatic in most patients. HHS Vulnerability Disclosure, Help See this image and copyright information in PMC. Online ahead of print. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The origin of MDACL may be degenerative or traumatic. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. ACL tears don't heal as such. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. -. Bergin D, Morrison WB, Carrino JA et-al. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Pain was posterior in 23 knees (80%). Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. HHS Vulnerability Disclosure, Help To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. The mean age at the time of surgery was 57 years (range, 31 to 78 years). Sweed, T., Mussa, M., El-Bakoury, A. et al. Please enable it to take advantage of the complete set of features! Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Its signal is increased on all sequences. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Second, methodological quality assessment showed that three studies had low methodological quality. The .gov means its official. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. 2004;182 (5): 1283-7. 2011. reported on the co-existence of mucoid degeneration and ganglia of the ACL. Accessibility Copyright 2010 Elsevier Masson SAS. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. These appearances must be differentiated from mucoid degeneration of the intact ACL. CAS All patients (100%, n=11) reported an improvement in pain. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Methods: The minimum follow-up was 3 years. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. 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 . in 1999 [1]. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . Introduction: Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Background: Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. 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. Preoperative magnetic resonance imaging (MRI) scan. PROSPERO. Careers. This systematic review has some limitations. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. 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. 2. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. Arthroscopy 24(6):642649. sharing sensitive information, make sure youre on a federal We herein describe a case of PCL mucoid degeneration presented with secondary ACL . 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. Seventeen females (67%) and eight males (33%) were included in the final analysis. Methods: Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. Hypothesis: to 44% in the study of Cha et al. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. bling. Arthroscopy. 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. 2 ). It is a chronic degenerative change of a bulky ACL that may lead to notch . The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. reported the largest percentage of patients (27.5%) with a positive pivot test. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. Cite this article. Epub 2008 Apr 18. In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. -, Fealy S, Kenter K, Dines JS, Warren RF. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Advanced MR imaging of the cruciate ligaments. The .gov means its official. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. This site needs JavaScript to work properly. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. 2007;15 (1): 73-86. All nine studies assessed the outcome of arthroscopic debridement of MDACL. What causes mucoid degeneration of ACL? Before (A) Bulging of, Fig. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. You can read more if you want. . Noninfiltrating synovial cysts of the ACL were excluded. -, 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. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Epub 2011 Feb 18. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. 2011 Jun;25(6):650-2. Epub 2021 Mar 8. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. 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]. Khanna et al. government site. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. A 48-year-old-male patient presented with knee pain and limitation of motion. eCollection 2022 May-Jun. 2. 2001;17(9):E37. did not report on this. Cookies policy. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Eight studies reported postoperative instability. J Clin Epidemiol 62(10):10061012. 1999;81(2):304305. Unable to load your collection due to an error, Unable to load your delegates due to an error. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Epub 2018 Jan 2. 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. Morice et al. Two patients uderwent secondary ligamentoplasty. Accessibility 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. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. mucoid degeneration of acl mri. The appearance can mimic acute or chronic interstitial partial tears of the ACL. https://doi.org/10.1302/0301-620X.81B2.0810304, Article Would you like email updates of new search results? Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Therefore, indications for ACL resection must be carefully selected. National Library of Medicine Along with that, it also controls the internal rotation. 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. Arthroscopy 20(2):141146. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. The .gov means its official. Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. The author(s) read and approved the final manuscript. 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). The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. 8600 Rockville Pike Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. 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 ). Answer (1 of 2): Most of the time mucoid degenrative changes in the ACL does not cause any problemonly if u have sign of ACL instability or the bending of the knee is reduced you may need a arthroscopic evaluation usually u may skip without ACL reconstruction but some of us will need AcL recons. Generally, we know little about this condition. 1. The rate of simultaneous meniscectomy ranged from 13 to 44%. 1). Correspondence to This site needs JavaScript to work properly. Disclaimer. The origin of MDACL may be degenerative or traumatic. There was an improvement in postoperative range of motion and outcome scores (Lysholm and International Knee Documentation Committee scores and the Knee Injury and Osteoarthritis Outcome Score). The authors declare that they have no competing interests. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. Dietary management and various treatments Scanning and diagnostic . 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. report that one patient had ACL reconstruction simultaneously after the ACL debridement. Method. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. 2011. Symptomatic ACL mucoid degeneration in middle-age athletes. 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. Level of evidence: Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. Careers. Only nine studies met our inclusion criteria and they were all case series. It results in postoperative laxity, but rarely in frank instability. Knee Surg Sports Traumatol Arthrosc. Open Grey database was searched for grey literature using the same keywords. 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). 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. 2004;182(5):12837. Epub 2018 Aug 22. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). It may lead to knee pain. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. 2009. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. FOIA 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. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Knee Surg Sports Traumatol Arthrosc. The mean MINORS score was 9.5 (range 412). The clinical presentation is one of posterior pain with limited flexion. Patients will . Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. All nine studies were case series; six were retrospective and three were prospective studies. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. Epub 2010 May 8. official website and that any information you provide is encrypted 2012;4 (2): 167-70. Knee Surgery, Sports Traumatology, Arthroscopy. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. 2011;19(3):408411. Springer Nature. Introduction: A total of 313 knees in 292 patients were included in the nine studies. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Symptoms included limited range of motion (ROM) and posterior knee pain. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. Arthroscopic findings. 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. 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. Mucoid cystic degeneration of the cruciate ligament.
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