MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. . 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. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. MeSH How to Treat ACL Mucoid Degeneration? - HTQ eCollection 2013. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. National Center for Biotechnology Information ACL tears don't heal as such. HHS Vulnerability Disclosure, Help Arthroscopic management of mucoid degeneration of anterior cruciate ligament. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. Clin Orthop Surg. International Journal of Orthopaedics. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. In six of the nine studies [6, 14, 16,17,18], arthroscopic debridement of the ACL was associated with simultaneous partial meniscectomy; this ranged from 13% in the study of Morice et al. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. Privacy Orthop Traumatol Surg Res. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. Clin Orthop Surg 10(3):307314. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. Individuals with mucoid degeneration of the ACL were excluded. Reeducation. Before 8600 Rockville Pike Epub 2011 Feb 18. Chudasama et al. KoreaMed Synapse Ligaments are very tough, fibrous tissue structures. in 1999 [1]. Disclaimer. The extracted data were heterogeneous in terms of outcome assessment. J Chin Med Assoc. . Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. ACL debridement was partial in all studies except for those by Lintz et al. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. (PDF) Assessment of imaging, pathoanatomy and - Academia.edu 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. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. 2. Postoperative recovery was four weeks on average. Unable to load your collection due to an error, Unable to load your delegates due to an error. The minimum follow-up was 3 years. What does mucoid degeneration of posterior horn of medial - HealthTap Advanced MR imaging of the cruciate ligaments. eCollection 2021. Characteristic: "celery stalk" appearance. 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. Disclaimer. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. The cause is not really known, but patients usually do not complain of instability. 2018;4(4):875-80. Mucoid degeneration of the anterior cruciate ligament - PubMed Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. sharing sensitive information, make sure youre on a federal 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. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 1. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. . 2. 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. Epub 2021 Nov 24. TS designed the project, literature search and wrote the manuscript. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. PubMedGoogle Scholar. Unable to load your collection due to an error, Unable to load your delegates due to an error. Eight studies reported postoperative instability. JBR-BTR. Mucoid Degeneration of the Anterior Cruciate Ligament - ResearchGate Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. Knee. Diffuse Intrasubstance Signal Abnormalities Ofthe Posterior Cruciate Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Bethesda, MD 20894, Web Policies Springer Nature. Symptoms included limited range of motion (ROM) and posterior knee pain. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Symptomatic ACL mucoid degeneration in middle-age athletes Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Unauthorized use of these marks is strictly prohibited. Before There was an improvement in postoperative range of motion and outcome scores (Lysholm and International Knee Documentation Committee scores and the Knee Injury and Osteoarthritis Outcome Score). Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid The extracted data were assessed for meta-analysis. Please enable it to take advantage of the complete set of features! Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. Arthroscopy. 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. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. It can cause pain and to a meniscal tear. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. HHS Vulnerability Disclosure, Help Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. 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. as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. Epub 2013 Aug 27. 2 ). 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. GG and AM interpreted the results and reviewed the manuscript. 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. . 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). ANZ J Surg 73(9):712716. This site needs JavaScript to work properly. Introduction: Mucoid degeneration of both ACL and PCL. PMC J Clin Epidemiol 62(10):10061012. At the time the article was created Frank Gaillard had no recorded disclosures. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Knee Surg Sports Traumatol Arthrosc. 2021 Sep;50(9):1837-1843. doi: 10.1007/s00256-021-03750-7. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Would you like email updates of new search results? . Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. reported on the co-existence of mucoid degeneration and ganglia of the ACL. Would you like email updates of new search results? 2007;245 (3): 916-7. Other theories include Degenerative theory- MD could occur due to ageing.[3]. 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. PROSPERO. Anterior cruciate ligament mucoid degeneration: MR findings 1992;159(2):35760. The mean follow up ranged from 13 to 72months. Cookies policy. Glossary of terms for musculoskeletal radiology. 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 https:// ensures that you are connecting to the (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). PubMed 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. Fourteen knees (48%) had limited flexion, on average 97 degrees. 5. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. The origin of MDACL may be degenerative or traumatic. 2004;182(5):12837. ACL Mucoid Degeneration in Knee - Diagnosis & Treatment | Dr. Hemendra Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. 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. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. reported the largest percentage of patients (27.5%) with a positive pivot test. 2011 Jun;25(6):650-2. Anterior cruciate ligament mucoid degeneration. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. J Arthrosc Joint Surg 3(1):2833. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. 2007;90(3):1923. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Online ahead of print. Its signal is increased on all sequences. 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. Mucoid degeneration of the anterior cruciate ligament: Partial However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. Khanna et al. The site is secure. It results in postoperative laxity, but rarely in frank instability. PMC Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. Bergin D, Morrison WB, Carrino JA et-al. 2011. Arthroscopic findings. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. 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). Cureus | Anterior Cruciate Ligament Ganglion Cyst and Mucoid eCollection 2022 May-Jun. National Library of Medicine Method. 2006;69(9):44952. The site is secure. Preoperative and postoperative results of eleven patient were compared. Mucoid degeneration of anterior cruciate ligament (ACL) Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. MM and A performed the literature search, and data analysis. Mumbai, Maharashtra, India. AJR Am J Roentgenol. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. and transmitted securely. Please enable it to take advantage of the complete set of features! 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 ). There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. Federal government websites often end in .gov or .mil. 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. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. This makes it difficult to relate the improvement of symptoms to ACL debridement. (A) Bulging of the hypertrophied anterior cruciate ligament. Disclaimer. HHS Vulnerability Disclosure, Help Le signe de la branche de cleri - ResearchGate No treatment is usually required. AJR Am J Roentgenol. The quality of methodology was excellent in one study, good in five studies, low in two studies and very low in one study (Tables 1 and 2). An official website of the United States government. See this image and copyright information in PMC. Conclusions: 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. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. J Sports Med Phys Fitness 48(4):483487, PubMed [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. 1. (Table 3). An official website of the United States government. https://doi.org/10.4103/0019-5413.128765, Article There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Symptomatic ACL mucoid degeneration in middle-age athletes. [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%). Radiofrequency Ablation for Mucoid Degeneration of the Anterior Epub 2018 Jun 13. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). HHS Vulnerability Disclosure, Help They respond well to a judicious arthroscopic release of the ACL with notchplasty. 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. https://doi.org/10.1016/j.jclinepi.2009.06.005. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. Federal government websites often end in .gov or .mil. Epub 2018 Jan 2. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Mucoid degeneration of the anterior cruciate ligament Epub 2021 Mar 8. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. sharing sensitive information, make sure youre on a federal Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). Multiple theories have been put forth that explains the pathological disorganization in the collagen fibers of the Anterior Cruciate Ligament, such as synovial, traumatic, and degenerative, "Synovial theory- states that there is accumulation of synovial fluid inside the substance of ACL in a herniated pouch of synovium. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. How is mucoid degeneration treated? - Sdnimik.bluejeanblues.net This site needs JavaScript to work properly. 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. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. Arthroscopic management of mucoid degeneration of anterior cru Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Individuals were included in the study if they had had complete MRIs of the affected knee at baseline and at 4-year follow-up, had thigh MRIs at baseline and had no additional surgery in the meantime. Papadopoulou P. The celery stalk sign. 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. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. At the time the article was last revised Dai Roberts had no recorded disclosures. This site needs JavaScript to work properly. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). The pathogenesis remains controversial. (A) Bulging of, Fig. The https:// ensures that you are connecting to the Skeletal Radiol. Unable to load your collection due to an error, Unable to load your delegates due to an error. A total of 313 knees in 292 patients were included in the nine studies. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. 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 success of treatment for MDACL and the subsequent risk of instability is not known. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. mucoid degeneration of acl mri. Would you like email updates of new search results? By using this website, you agree to our Meniscectomy was undertaken in 11 cases (41%). 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. 2012;4 (2): 167-70. 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. Anterior cruciate ligament mucoid degeneration: a review of the Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 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]. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. Categories were determined in accordance with the study of Ekhtiari et al. Dietary management and various treatments Scanning and diagnostic . Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. J Bone Joint Surg Ser B 81(2):304305. Truncation means that the . National Library of Medicine PDF Mucoid degenerated anterior cruciate ligament managed by arthroscopic 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. 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. California Privacy Statement, Please enable it to take advantage of the complete set of features! 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. The authors declare that they have no competing interests. The .gov means its official. Sagittal T2-weighted MRI view showing intact anterior, Fig. A total of 313 knees in 292 patients were included. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. Any discrepancy was resolved by the senior author. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. 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. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. sharing sensitive information, make sure youre on a federal Anterior cruciate ligament mucoid degeneration: selecting the best Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a 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 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). 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. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Unauthorized use of these marks is strictly prohibited. Unauthorized use of these marks is strictly prohibited.
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