Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH 1. 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). Partial/Total ACL resection arthroscopically- There is marked improvement in the range and reduced posterior pain, but at the cost of increased post-operative knee laxity. Bethesda, MD 20894, Web Policies 2011 Mar;25(3):262-5. The https:// ensures that you are connecting to the Postoperative clinical laxity was common, however, symptomatic instability was not. 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. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Case report: 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. The https:// ensures that you are connecting to the Would you like email updates of new search results? 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. 2007;90(3):1923. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. The mean MINORS score was 9.5 (range 412). Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. 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. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. There is no consensus on treatment and evidence is scarce. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. 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. . Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. 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. Generally, we know little about this condition. When refering to evidence in academic writing, you should always try to reference the primary (original) source. 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). Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. 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. Unable to process the form. Patient having mucoid degeneration of ACL seeks multiple orthopedic consultation and most of the time treating orthopedican miss its diagnosis either because of lack of experience or rare cause of pain unless doctor sought magnetic resonance imaging (MRI) of knee. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. This was lowest in the study of Cha et al. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. 2009. 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 author(s) read and approved the final manuscript. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. -. Mucoid degeneration of the anterior cruciate ligament. Mucoid degeneration of the anterior cruciate ligament. The anterior cruciate ligament (ACL) is an important ligament in the knee. government site. ACL debridement was partial in all studies except for those by Lintz et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. . See this image and copyright information in PMC. The mean age at the time of surgery was 57 years (range, 31 to 78 years). Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Patients and methods: 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. and Ventura et al. Bethesda, MD 20894, Web Policies I have persistent pain in the back of that knee that is exacerbated by walking and bending it. 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Epub 2008 Dec 17. Physical therapy typically begins 7-10 days after the procedure. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. 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. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. MM and A performed the literature search, and data analysis. in 1999 [1]. Mucoid degeneration of ACL is a disease affecting ACL in which mucoid like substance (glycosaminoglycans) gets interspersed within the substance of ACL and as a result ACL gets thickened. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. The need for simultaneous or delayed ACL reconstruction should be discussed with patients in case total resection of the ACL is to be performed, particularly in young active patients. 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. https://doi.org/10.2214/ajr.182.5.1821283, Article 2012;4 (2): 167-70. 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). 1992;159(2):35760. A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, most pronounced at 6-7 and small disc herniations at 5-6 and C4-5, with slight interval progression at 5-6. . : A Meta-Analysis. Categories were determined in accordance with the study of Ekhtiari et al. Epub 2018 Apr 21. PubMedGoogle Scholar. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Arch Orthop Trauma Surg. This study concerns complete ACL resec Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. By using this website, you agree to our All patients (100%, n=11) reported an improvement in pain. 2018;4(4):875-80. FOIA Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . Arthroscopy. volume33, Articlenumber:26 (2021) https://doi.org/10.1007/s00167-011-1433-0, Article 2011. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. to 44% in the study of Cha et al. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. These appearances must be differentiated from mucoid degeneration of the intact ACL. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. The clinical presentation is one of posterior pain with limited flexion. 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). Unauthorized use of these marks is strictly prohibited. Fourteen knees (48%) had limited flexion, on average 97 degrees. 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. Arthroscopic findings. Patients will . Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Would you like email updates of new search results? Knee Surg Sports Traumatol Arthrosc. For non-comparative studies, this consists of eight questions. National Library of Medicine Knee. 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. The mean follow up ranged from 13 to 72months. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. All patients (100%, n=11) reported a good to very good surgery satisfaction. 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 Dietary management and various treatments Scanning and diagnostic . Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 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). FOIA Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. 2007;15 (1): 73-86. Correspondence to The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. PMC However, MDACL is asymptomatic in most patients. [Diagnosis and treatment of anterior cruciate ligament cysts]. 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 ]. Cite this article. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Bethesda, MD 20894, Web Policies Truncation means that the . Anatomopathology samples were collected in 18 cases. 2. Its signal is increased on all sequences. National Library of Medicine Average improvement in flexion was 21.5 degrees (0 to 60 degrees). The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. What you feel (symptoms) You feel heaviness in knee joint. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. 2001;30(6):312315. 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 . 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Noninfiltrating synovial cysts of the ACL were excluded. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. MeSH The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. Mucoid degeneration of the anterior cruciate ligament. 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. Bethesda, MD 20894, Web Policies Only nine studies met our inclusion criteria and they were all case series. Clin Orthop Surg. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. 2. J Bone Joint Surg Br. 1 Its prevalence in magnetic resonance imaging (MRI) is 1.8-5.3%, but not all lesions are symptomatic.2, 3 It is characterized by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. What is myxoid degeneration treatment? The mean age of patients ranged from 31 to 78years. The .gov means its official. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. 2004;182 (5): 1283-7. 2023 BioMed Central Ltd unless otherwise stated. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. 3. 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. Arthroscopy 24(6):642649. Disclaimer. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Twelve partial and 17 total resections were performed. Epub 2018 Jun 13. Knee Surgery, Sports Traumatology, Arthroscopy. The mean follow up ranged from 13 to 72months. An official website of the United States government. Presentation Patients usually present with nonspecific posterior knee pain with restriction of flexion. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. 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. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. 2001;17(9):E37. W B Saunders Co. (2005) ISBN:0721602703. statement and Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). official website and that any information you provide is encrypted Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Arthroscopic findings. It results in postoperative laxity, but rarely in frank instability. Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? reported on the co-existence of mucoid degeneration and ganglia of the ACL. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Results: Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. It is a chronic degenerative change of a bulky ACL that may lead to notch . Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. The appearance can mimic acute or chronic interstitial partial tears of the ACL. (Table 3). PMC Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. 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 hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. The .gov means its official. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Method. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). government site. 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. 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. Ligaments are very tough, fibrous tissue structures. Careers. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. 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 ). J Knee Surg. See this image and copyright information in PMC. Postoperative pain relief was reported in seven studies. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. 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. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. 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. Meniscectomy was undertaken in 11 cases (41%). 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. What Is Mucoid Degeneration of the ACL? ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Part of 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. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Conclusion: Treatment of ACL mucoid degeneration by this modality is effective in preventing recurrence, post-operative laxity and provides better functional outcome compared to the classical partial resection of the degenerated ACL. The site is secure. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. Knee Surgery & Related Research 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. Physical Therapy. Epub 2008 Apr 18. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. https://doi.org/10.1186/s43019-021-00110-6, DOI: https://doi.org/10.1186/s43019-021-00110-6. Level of Evidence: Level IV. Epub 2018 Jan 2. (A) Bulging of the hypertrophied anterior cruciate ligament. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . 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. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). It can cause pain and to a meniscal tear. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. [16]. Morice et al. This systematic review has some limitations. Reeducation. HHS Vulnerability Disclosure, Help Arthroscopy. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Privacy IV (retrospective cohort study). 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). A long duration of non-specific knee pain in a patient should be evaluated with MRI. Roberts CC, Towers JD, Spangehl MJ et-al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Conclusions. 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.