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]. 1173185. Physiotherapy. (100%). Mucinous material within the substance of ACL produces pain and limited motion in the knee. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. 2012;4 (2): 167-70. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. 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. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). Initially, partial weightbearing is allowed. Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). Bookshelf Imaging: Plain radiographs Read More Created for people with ongoing healthcare needs but benefits everyone. 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. 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. 1999;81(2):304305. 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. Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. Arthroscopy. -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. volume33, Articlenumber:26 (2021) Twelve partial and 17 total resections were performed. We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. What is Anterior Cruciate Ligament Mucoid Degeneration? 2011 Mar;25(3):262-5. 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. On clinical examination, the active range of motion showed a flexion deficit. 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. #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Knee Surg Sports Traumatol Arthrosc 21(3):658663. Knee Surg Sports Traumatol Arthrosc. 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. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . . Clin Orthop Surg 10(3):307314. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Patients and methods: Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. PubMed Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. The authors declare that they have no competing interests. in 1999 [ 1 ]. Federal government websites often end in .gov or .mil. Chudasama et al. Bookshelf The appearance can mimic acute or chronic interstitial partial tears of the ACL. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Level of evidence: 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). Its signal is increased on all sequences. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. HHS Vulnerability Disclosure, Help When refering to evidence in academic writing, you should always try to reference the primary (original) source. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Accessed 1 Mar 2021. 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. 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. For non-comparative studies, this consists of eight questions. (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). A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. [16]. sharing sensitive information, make sure youre on a federal The mean follow up ranged from 13 to 72months. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. ADVERTISEMENT: Supporters see fewer/no ads. The patient presented with extension block of the knee. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. MeSH -, Makino A, Pascual-Garrido C, Rolon A, Isola M, Muscolo DL. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. : A Meta-Analysis. Magn Reson Imaging Clin N Am. 2004;182 (5): 1283-7. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. No treatment is usually required. Furthermore, this raises the question as to whether the symptoms (pain and diminished range of movement) were solely due to MDACL and not secondary to other associated pathological conditions. Meniscectomy was undertaken in 11 cases (41%). ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . (B) Partial resection, MeSH 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Correspondence to To our knowledge, this is the first systematic review to look into the results of the management of MDACL. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Epub 2011 Feb 18. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. Indian J Orthop 46(5):561565. Mumbai, Maharashtra, India. Seventeen females (67%) and eight males (33%) were included in the final analysis. and transmitted securely. Khanna et al. 3. Sagittal T2-weighted MRI view showing intact anterior, Fig. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Arthroscopy. A total of 313 knees in 292 patients were included in the nine studies. Postoperative clinical laxity was common, however, symptomatic instability was not. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. eCollection 2022 May-Jun. 6. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Level of Evidence: Level IV. MDACL is differentiated from synovial cysts of the anterior cruciate ligament (ACL) where, in MDACL, mucoid tissue intermingles within ACL fibres and is not contained within a cyst [3]. CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. Manage cookies/Do not sell my data we use in the preference centre. 2007;90(3):1923. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. HHS Vulnerability Disclosure, Help Clipboard, Search History, and several other advanced features are temporarily unavailable. Arthroscopic findings. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. 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. official website and that any information you provide is encrypted Clipboard, Search History, and several other advanced features are temporarily unavailable. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. However, MDACL is asymptomatic in most patients. The site is secure. government site. The site is secure. You can read more if you want. Disclaimer. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Keywords: California Privacy Statement, The retrospective study by Kim et al. Clin Orthop Surg. Knee Surg & Relat Res 33, 26 (2021). and Ventura et al. Mucoid degeneration of the anterior cruciate ligament (ACL) is regarded as a degenerative change in the ligament, which is clinically presented with pain on full extension or flexion in the middle-aged population. 2013;15(1). Federal government websites often end in .gov or .mil. Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. Conclusions: Method. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Glossary of terms for musculoskeletal radiology. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. https://doi.org/10.1016/j.jajs.2015.12.001, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J (2018) Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Resnick D, Kransdorf MJ. Hypothesis: 2011;19(3):408411. Provided by the Springer Nature SharedIt content-sharing initiative. National Library of Medicine proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. 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). Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Anterior Cruciate Ligament, is an important structure of the knee joint. 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 . Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Please enable it to take advantage of the complete set of features! Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. and transmitted securely. [6], in 62% of patients (18 of 29) in the study of Lintz et al. FOIA Here are the search results of the thread mucoid degeneration of acl treatment from Bing. A total of 313 knees in 292 patients were included. 2011 Aug 1;19(8):1326-33. Federal government websites often end in .gov or .mil. PMC Papadopoulou P. The celery stalk sign. 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. Introduction: Knee Surg Sports Traumatol Arthrosc. Arthroscopy 24(6):642649. Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. 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. 2021 Sep;50(9):1837-1843. doi: 10.1007/s00256-021-03750-7. Categories were determined in accordance with the study of Ekhtiari et al. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. International Journal of Orthopaedics. By using this website, you agree to our Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Skeletal Radiology. Epub 2021 Nov 24. Cho SD, Youm YS, Lee CC et-al. PMC Epub 2011 Feb 18. ACL debridement was partial in all studies except for those by Lintz et al. AJR Am J Roentgenol. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. government site. Arthroscopic findings. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Springer Nature. However, the authors did not report whether there were any other patients with symptomatic instability. 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. 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. . Int J Curr Res Aca Rev 4(11):1824 http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI (2008) Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. Preoperative magnetic resonance imaging (MRI), Fig. Part of The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. At the time the article was last revised Dai Roberts had no recorded disclosures. [17] do not mention whether any patients underwent biopsy (Table 3). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Therefore, indications for ACL resection must be carefully selected. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Methods: The minimum follow-up was 3 years. FOIA Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. 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. Background: Epub 2008 Dec 17. Knee. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Clipboard, Search History, and several other advanced features are temporarily unavailable. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Pandey, Vivek et al. Generally, we know little about this condition. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. Results: Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. The https:// ensures that you are connecting to the 8600 Rockville Pike The total number of patients with symptomatic instability was 18 out of 288 (6%). Management of mucoid degeneration of the anterior cruciate ligament: a systematic . Intact fibers are best seen on T2WI. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Postoperative pain relief was reported in seven studies. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. 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. Morice et al. ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Bethesda, MD 20894, Web Policies HHS Vulnerability Disclosure, Help Therefore, indications for ACL resection must be carefully selected. Knee Surgery & Related Research [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. Arch Orthop Trauma Surg. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. 1. -. Clin Orthop Surg. in 1999 [1]. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). 5. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? (A) Bulging of the hypertrophied anterior cruciate ligament. Epub 2021 Mar 8. Bookshelf ANZ J Surg 73(9):712716. This is basically an MRI diagnosis of expansion and increased signal of an intact ACL in a person with knee pain which is worse on knee flexion/bending. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. 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. Radiology. 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. Unable to process the form. 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. 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. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. 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.