Skelet Radiol 30(6):312315. Two patients uderwent secondary ligamentoplasty. The mean MINORS score was 9.5 out of 16 (412). Introduction: Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-3615, Case 11: with Hoffa fat pad ganglion cyst, Case 12: tibial nerve schwannoma and ACL mucoid degeneration, Case 1: Complete ACL tear and meniscal tears, Case 2: Anomalous insertion of the medial meniscus, View Frank Gaillard's current disclosures, see full revision history and disclosures, anterior cruciate ligament ganglion cysts, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Mucoid degeneration of the anterior cruciate ligament, congenital or acquired synovial tissue entrapment between ACL fibers. 2004;182 (5): 1283-7. FOIA A long duration of non-specific knee pain in a patient should be evaluated with MRI. Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. Bookshelf sharing sensitive information, make sure youre on a federal Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. Clipboard, Search History, and several other advanced features are temporarily unavailable. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Please enable it to take advantage of the complete set of features! I get PT and acupuncture, have had several epidural injections, and am trying hard to avoid osteoporosis meds (was on bisphosphonates for many years many years ago) as well as spinal fusion. Knee Surg Sports Traumatol Arthrosc 21(3):658663. 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. The rate of simultaneous meniscectomy ranged from 13 to 44%. Sep 2017 - Feb 20186 months. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. [16]. 2007;15 (1): 73-86. Physical Therapy. Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. 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. . https://doi.org/10.4103/0019-5413.128765, Article Second, methodological quality assessment showed that three studies had low methodological quality. Arthroscopy. 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). The clinical presentation is one of posterior pain with limited flexion. 2004;182(5):12837. in 1999 [1]. sharing sensitive information, make sure youre on a federal 2012;4 (2): 167-70. Twelve partial and 17 total resections were performed. Mucoid degeneration of the ACL is a rare cause of knee pain.1-8) This lesion of the ACL was first reported by Kumar et al.3) in 1999. An official website of the United States government. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Mucoid degeneration of the anterior cruciate ligament. Keywords: Rehabilitation, orthophony, crenotherapy. PMC Questions just answered: mucoid degeneration of acl physiotherapy. 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. They respond well to a judicious arthroscopic release of the ACL with notchplasty. 1999;81(2):304305. Intact fibers are best seen on T2WI. 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. 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. (A) Bulging of, Fig. 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. J Arthrosc Joint Surg 3(1):2833. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. FOIA [6], in 62% of patients (18 of 29) in the study of Lintz et al. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. Bookshelf Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Google Scholar, Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D (2011) Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. Federal government websites often end in .gov or .mil. official website and that any information you provide is encrypted To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. The origin of MDACL may be degenerative or traumatic. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. All nine studies were case series; six were retrospective and three were prospective studies. Seventeen females (67%) and eight males (33%) were included in the final analysis. 8600 Rockville Pike In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. 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. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. what causes mucoid degeneration of acl. Bethesda, MD 20894, Web Policies as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. . We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. 2011 Jun;25(6):650-2. This site needs JavaScript to work properly. mucoid degeneration acl symptoms. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. Clipboard, Search History, and several other advanced features are temporarily unavailable. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Conclusions. 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. It can cause pain and to a meniscal tear. [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. PMC This is a rare pathological condition, in which, there is increased signal from within the ligament. Symptomatic ACL mucoid degeneration in middle-age athletes. What you feel (symptoms) You feel heaviness in knee joint. 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. That is usually the journal article where the information was first stated. Springer Nature. J Knee Surg. 2010 Jun 1;96(4):400-6. reported on the co-existence of mucoid degeneration and ganglia of the ACL. By using this website, you agree to our Score: 4.7/5 (45 votes) . Eight studies reported postoperative instability. 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. to 44% in the study of Cha et al. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. It is a chronic degenerative change of a bulky ACL that may lead to notch . 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. 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. Knee Surgery & Related Research 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. Skeletal Radiology. 1173185. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . The site is secure. 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. Privacy (48.2% (14/29 patients) with symptomatic instability), which may be due to the large number of patients with total resection of the ACL (58.6% (17 out of 29 patients)) (Table 4). 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. An 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 mucoid degeneration: a review of the literature and management guidelines. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Epub 2011 Feb 18. J Sports Med Phys Fitness 48(4):483487, PubMed A total of 313 knees in 292 patients were included in the nine studies. Hypothesis: 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. Mucoid degeneration of the anterior cruciate ligament. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. in 1999 [1]. Methods: The minimum follow-up was 3 years. Other theories include Degenerative theory- MD could occur due to ageing.[3]. Postoperative clinical laxity was common, however, symptomatic instability was not. 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). 2018;4(4):875-80. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. . Mucoid degeneration of ACL. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. official website and that any information you provide is encrypted This site needs JavaScript to work properly. Introduction: J Clin Epidemiol 62(10):10061012. Epub 2018 Aug 22. Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was debrided. Would you like email updates of new search results? 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 . Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. 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). 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). 2. Unauthorized use of these marks is strictly prohibited. -Evaluated and planned treatment protocol in accordance with physician. Postoperative recovery was four weeks on average. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Accessibility A total of 313 knees in 292 patients were included. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Epub 2018 Jun 13. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. No treatment is usually required. This appearance can mimic acute or chronic interstitial partial tears of the ligament. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. 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. Preoperative magnetic resonance imaging (MRI) scan. Orthopaedics & Traumatology: Surgery & Research. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). (100%). Rehabilitation, speech therapy, crenotherapy. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Pandey, Vivek et al. JBR-BTR. Instrumental treatment. Hamdaoui and others published Le signe de la branche de cleri | Find, read and cite all the research you need on ResearchGate Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. 2011 Aug 1;19(8):1326-33. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon non-traumatic cause of knee pain and motion restriction, typically seen in a middle-aged population. Arch Orthop Trauma Surg. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. There is no consensus on treatment and evidence is scarce. Unable to load your collection due to an error, Unable to load your delegates due to an error. Unauthorized use of these marks is strictly prohibited. Epub 2008 Apr 18. Truncation means that the . Disclaimer. Morice et al. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. 2011. 2021 Sep;50(9):1837-1843. doi: 10.1007/s00256-021-03750-7. In the nine included studies, four different scores were used for outcome assessment. MeSH Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. All rights reserved. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. ANZ J Surg 73(9):712716. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Advanced MR imaging of the cruciate ligaments. HHS Vulnerability Disclosure, Help Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. 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 ]. Arthroscopy 24(6):642649. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. 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). Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. What Is Mucoid Degeneration of the ACL? The cause is not really known, but patients usually do not complain of instability. 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 degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Glossary of terms for musculoskeletal radiology. Am J Roentgenol 182(5):12831287. Bergin et al. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. 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). Before Only nine studies met our inclusion criteria and they were all case series. Bethesda, MD 20894, Web Policies Unauthorized use of these marks is strictly prohibited. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. The retrospective study by Kim et al. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). mucoid degeneration of acl mri. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. 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. This makes it difficult to relate the improvement of symptoms to ACL debridement. Discussion: See this image and copyright information in PMC. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. The https:// ensures that you are connecting to the 1. Background: Learn how we can help 704 views Reviewed >2 years ago Thank Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Arthroscopy. Orthop Traumatol Surg Res. Therefore, indications for ACL resection must be carefully selected. 2009. NCI CPTC Antibody Characterization Program. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. Federal government websites often end in .gov or .mil. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Physiotherapy. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Meniscectomy was undertaken in 11 cases (41%). A positive Lachman test and a negative pivot shift were noted after surgery in all cases. . 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. Indian J Orthop 48(2):197202. 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. Epub 2013 Aug 27. 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. Please enable it to take advantage of the complete set of features! Knee Surg Sports Traumatol Arthrosc. Clipboard, Search History, and several other advanced features are temporarily unavailable. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes.
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