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Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. did not report on this. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. The minimum follow-up was 3 years. FOIA Knee. https://doi.org/10.1016/j.arthro.2008.02.004, Morice A, Coupry A, Lintz F, Robert H (2013) Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Federal government websites often end in .gov or .mil. 8600 Rockville Pike Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Clin Orthop Surg. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. eCollection 2021. Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. Terms and Conditions, J Chin Med Assoc. At the time the article was created Frank Gaillard had no recorded disclosures. Arthroscopic debridement may help relieve the anterior knee pain. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Knee Surg Sports Traumatol Arthrosc. All patients (100%, n=11) reported an improvement in pain. Second, methodological quality assessment showed that three studies had low methodological quality. 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 ]. Epub 2021 Mar 8. The .gov means its official. Resnick D, Kransdorf MJ. Copyright 2010 Elsevier Masson SAS. 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.). Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Epub 2018 Jun 13. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. 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). Clipboard, Search History, and several other advanced features are temporarily unavailable. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. The site is secure. The rate of simultaneous meniscectomy ranged from 13 to 44%. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Mucoid degeneration of the anterior cruciate ligament. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Four studies reported only postoperative scores, which were comparable to those in other studies. Check for errors and try again. Epub 2008 Dec 17. The site is secure. Ventura et al. There was strong association with chondral lesions and meniscal tears. 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. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. AJR Am J Roentgenol. 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. Clin Orthop Surg 10(3):307314. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. An official website of the United States government. https://doi.org/10.1302/0301-620X.81B2.0810304, Article For non-comparative studies, this consists of eight questions. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. This site needs JavaScript to work properly. 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. National Library of Medicine Orthop Traumatol Surg Res 96(4):400406, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. Epub 2013 Aug 27. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. Bethesda, MD 20894, Web Policies Rehabilitation, speech therapy, crenotherapy. 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. https://doi.org/10.4055/cios.2018.10.3.307, University Hospitals of Derby and Burton, Uttoxeter Rd, Derby, DE22 3NE, UK, Trauma and Orthopaedic Speciality Trainee, West Midlands Deanery, Birmingham Rotation, Birmingham, UK, University Hospitals Plymouth NHS Trust, Plymouth, UK, University of Alexandria, Alexandria, Egypt, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK, You can also search for this author in Cho SD, Youm YS, Lee CC et-al. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. A long duration of non-specific knee pain in a patient should be evaluated with MRI. These appearances must be differentiated from mucoid degeneration of the intact ACL. 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). Patients and methods: 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 . 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. Mucoid degeneration of both ACL and PCL. Any discrepancy was resolved by the senior author. Physical Therapy. The total number of patients with symptomatic instability was 18 out of 288 (6%). Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. 2010 Jun 1;96(4):400-6. It results in postoperative laxity, but rarely in frank instability. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. 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. https://doi.org/10.1016/j.jclinepi.2009.06.005. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Would you like email updates of new search results? ADVERTISEMENT: Supporters see fewer/no ads. 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. 2011 Jun;25(6):650-2. MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. (61years), which was the largest study and represented more than one third of the total patients included in this review. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. The .gov means its official. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). MeSH On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Anterior cruciate ligament mucoid degeneration. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. CAS However, MDACL is asymptomatic in most patients. The mean age of patients ranged from 31 to 78years. The https:// ensures that you are connecting to the The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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]. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Signal intensity of the anteromedial bundle (AMB) or posterolateral bundle (PLB) graft standardized to the intensity of the PCL was defined as signal intensity ratio (SIR). Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Characteristic: "celery stalk" appearance. Mumbai, Maharashtra, India. 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. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Advanced MR imaging of the cruciate ligaments. 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. Before Physiotherapy. Online ahead of print. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. IV (retrospective cohort study). Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Disclaimer. 2011 Mar;25(3):262-5. Magn Reson Imaging Clin N Am. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. 2. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. and transmitted securely. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Epub 2011 Feb 18. Questions just answered: mucoid degeneration of acl physiotherapy. 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. 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. 8600 Rockville Pike and Ventura et al. mucoid degeneration of acl mri. . Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Careers. 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/. MM and A performed the literature search, and data analysis. Background: Online ahead of print. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. 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 ligament is mainly responsible for restraining anterior translation of knee. FOIA https://doi.org/10.4103/0019-5413.101037, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligament management and functional outcome of 18 cases. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 2023 BioMed Central Ltd unless otherwise stated. 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. 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. Arch Orthop Trauma Surg. 2 ). 2013;15(1). 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. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was debrided. The origin of MDACL may be degenerative or traumatic. . Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Instrumental treatment. government site. Clipboard, Search History, and several other advanced features are temporarily unavailable. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. You can read more if you want. PMC In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Preoperative magnetic resonance imaging (MRI) scan. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. GG and AM interpreted the results and reviewed the manuscript. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2011. J Orthop. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. Accessibility The mean MINORS score was 9.5 (range 412). Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). 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. 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. Sep 2017 - Feb 20186 months. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. MeSH 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. report that one patient had ACL reconstruction simultaneously after the ACL debridement. 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 . 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. 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). Sweed, T., Mussa, M., El-Bakoury, A. et al. 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. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. . Epub 2013 Aug 27. 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. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. Mucinous material within the substance of ACL produces pain and limited motion in the knee. National Library of Medicine Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Its signal is increased on all sequences. and transmitted securely. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Epub 2018 Aug 22. 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]. The purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported. The retrospective study by Kim et al. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. 287 (3): 912-921. Chudasama CH, Chudasama VC, Prabhakar MM. PubMed This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Method. Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. On clinical examination, the active range of motion showed a flexion deficit. AJR Am J Roentgenol. An official website of the United States government.