Mucoid degeneration of ACL. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Level of Evidence: Level IV. to 44% in the study of Cha et al. 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. PMC Meniscectomy was undertaken in 11 cases (41%). Dietary management and various treatments Scanning and diagnostic . Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. Sagittal T2-weighted MRI view showing intact anterior, Fig. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. TS designed the project, literature search and wrote the manuscript. Open Grey database was searched for grey literature using the same keywords. Clipboard, Search History, and several other advanced features are temporarily unavailable. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. The .gov means its official. Twelve partial and 17 total resections were performed. Arthroscopy. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. 2020 Jun 2. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: a case report. Unauthorized use of these marks is strictly prohibited. mucoid degeneration acl symptoms. Hamdaoui and others published Le signe de la branche de cleri | Find, read and cite all the research you need on ResearchGate 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. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. The cause is not really known, but patients usually do not complain of instability. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. The origin of MDACL may be degenerative or traumatic. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. Clin Orthop Surg. The total number of patients with symptomatic instability was 18 out of 288 (6%). 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). [Diagnosis and treatment of anterior cruciate ligament cysts]. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. J Arthrosc Joint Surg 3(1):2833. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. 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. . 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. Physical Therapy. Epub 2018 Aug 22. 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. 2004;182(5):12837. Bethesda, MD 20894, Web Policies On clinical examination, the active range of motion showed a flexion deficit. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Clipboard, Search History, and several other advanced features are temporarily unavailable. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Epub 2013 Aug 27. (100%). Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Arthroscopy. No reconstruction was performed at the same time. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Bergin D, Morrison WB, Carrino JA et-al. What is myxoid degeneration treatment? GG and AM interpreted the results and reviewed the manuscript. Noninfiltrating synovial cysts of the ACL were excluded. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. The success of treatment for MDACL and the subsequent risk of instability is not known. The pathogenesis remains controversial. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. This site needs JavaScript to work properly. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. AJR Am J Roentgenol. Mucoid degeneration of the anterior cruciate ligament. Two patients uderwent secondary ligamentoplasty. Federal government websites often end in .gov or .mil. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. It results in postoperative laxity, but rarely in frank instability. When refering to evidence in academic writing, you should always try to reference the primary (original) source. 2001;30(6):312315. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Arthroscopic diagnostic criteria [7] are (1) continuous ACL fibres, (2) increased ACL volume, (3) yellowish-coloured material expressed on palpation and (4) loss of ACL synovial lining. Roberts CC, Towers JD, Spangehl MJ et-al. Imaging: Plain radiographs There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). ACL tears don't heal as such. See this image and copyright information in PMC. However, the authors did not report whether there were any other patients with symptomatic instability. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. The https:// ensures that you are connecting to the Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. The appearance can mimic acute or chronic interstitial partial tears of the ACL. PMC FOIA and transmitted securely. Bone and joint imaging. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Coronal proton density-weighted magnetic resonance, Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate, Sagittal proton density-weighted magnetic resonance, Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased, Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate, Pre-debridement arthroscopic view showing yellowish. PubMed Central ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Epub 2021 Mar 8. 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. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. Preoperative magnetic resonance imaging (MRI), Fig. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782. Knee Surg Sports Traumatol Arthrosc. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. 6. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. Four studies reported only postoperative scores, which were comparable to those in other studies. All patients (100%, n=11) reported a good to very good surgery satisfaction. 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. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. 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. CAS Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Preoperative magnetic resonance imaging (MRI) scan. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. J Orthop. Methods: The minimum follow-up was 3 years. Other theories include Degenerative theory- MD could occur due to ageing.[3]. Skeletal Radiology. Discussion: Hypothesis: Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Skeletal Radiol. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. 2008;24(6):642649. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Anterior Cruciate Ligament, is an important structure of the knee joint. The https:// ensures that you are connecting to the https://doi.org/10.1302/0301-620X.81B2.0810304, Article mucoid degeneration of acl mri. 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). Arthroscopy. 287 (3): 912-921. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. Radiology. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Disclaimer. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. sharing sensitive information, make sure youre on a federal PubMedGoogle Scholar. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. 1173185. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. However, MDACL is asymptomatic in most patients. Anterior knee pain is the more common complaint. 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. Arch Orthop Trauma Surg. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. MUCOID DEGENERATION OF ACL - ARTHROSCOPIC TREATMENT 2,375 views Sep 15, 2019 23 Dislike Dr. Prateek Joshi- Ortho 1.02K subscribers Notice Age-restricted video (based on Community Guidelines). The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. 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. and transmitted securely. did not report on this. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. [18] did not comment on an association between MDACL and chondral or meniscal lesions: after the exclusion of that report, the total number of patients with associated chondral lesions was 226 out of 275 patients (82%) and 190 patients had meniscal lesions (69%). What Is Mucoid Degeneration of the ACL? 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 . 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. The extracted data were heterogeneous in terms of outcome assessment. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . All rights reserved. Any discrepancy was resolved by the senior author. Results: Second, methodological quality assessment showed that three studies had low methodological quality. All nine studies were case series; six were retrospective and three were prospective studies. [16]. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). 1. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. 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). {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 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. 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. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. Chudasama CH, Chudasama VC, Prabhakar MM. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. Online ahead of print. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. eCollection 2022 May-Jun. Before Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. This appearance can mimic acute or chronic interstitial partial tears of the ligament. National Library of Medicine 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). Average patient age was 49 (22 to 68) years. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Morice et al. NCI CPTC Antibody Characterization Program. Mucoid degeneration of both ACL and PCL. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. in 1999 [ 1 ]. Correspondence to 3. 2007;15 (1): 73-86. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. The mean age of patients ranged from 31 to 78years. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. The https:// ensures that you are connecting to the Magn Reson Imaging Clin N Am. Introduction: . 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. Results: Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. CAS It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Truncation means that the . Online ahead of print. Symptoms included limited range of motion (ROM) and posterior knee pain. Cho SD, Youm YS, Lee CC et-al. Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. (A) Bulging of, Fig. 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). Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. PubMed In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. ACL debridement was partial in all studies except for those by Lintz et al. Introduction: 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. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Anatomopathology samples were collected in 18 cases. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 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). 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. Knee Surg Sports Traumatol Arthrosc. 2004;182 (5): 1283-7. J Sports Med Phys Fitness 48(4):483487, PubMed government site. 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]. JBR-BTR. 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. 5. In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. An official website of the United States government. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. Arthroscopy 24(6):642649. Check for errors and try again. government site. In the nine included studies, four different scores were used for outcome assessment. 1). Orthopedics; anterior cruciate ligament; arthoscopy. Accessed 1 Mar 2021. 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. 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. 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. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Please enable it to take advantage of the complete set of features! By using this website, you agree to our Reeducation. 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. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Epub 2013 Aug 27. Pan African Medical Journal. Would you like email updates of new search results? Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Morice et al. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). reported the largest percentage of patients (27.5%) with a positive pivot test. 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. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact.
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