https://doi.org/10.4055/cios.2018.10.3.307, University Hospitals of Derby and Burton, Uttoxeter Rd, Derby, DE22 3NE, UK, Trauma and Orthopaedic Speciality Trainee, West Midlands Deanery, Birmingham Rotation, Birmingham, UK, University Hospitals Plymouth NHS Trust, Plymouth, UK, University of Alexandria, Alexandria, Egypt, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK, You can also search for this author in Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. At the time the article was last revised Dai Roberts had no recorded disclosures. Hypothesis: 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 minimum follow-up was 3 years. The site is secure. Orthop Traumatol Surg Res. 2018;4(4):875-80. 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. -. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Sep 2017 - Feb 20186 months. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. Arthroscopy 20(2):141146. J Chin Med Assoc. (A) Bulging of, Fig. Skelet Radiol 30(6):312315. Mucoid change or mucoid degeneration refers to the irreversible tissue degeneration due to the accumulation of mucin within the fibers of tendons, ligaments, and fibrocartilage. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. Ventura et al. 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 . 287 (3): 912-921. Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. 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. 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. Mucoid degeneration of the anterior cruciate ligament. Careers. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Federal government websites often end in .gov or .mil. 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. 2018. http://journals.sagepub.com/doi/10.1177/2325967118786930, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. There was strong association with chondral lesions and meniscal tears. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2001;30(6):312315. Radiology. Rehabilitation, speech therapy, crenotherapy. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. Preoperative and postoperative results of eleven patient were compared. Bookshelf Knee Surgery, Sports Traumatology, Arthroscopy. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. 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). Manage cookies/Do not sell my data we use in the preference centre. Before The site is secure. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. This site needs JavaScript to work properly. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. 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. NCI CPTC Antibody Characterization Program. 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. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. No treatment is usually required. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and MethodsBetween December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis . The .gov means its official. 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. 1. Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population-A 2-Year Follow-up Study. 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. . The knee is a complex synovial joint that can be affected by a range of pathologies: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Epub 2018 Jan 2. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. . Characteristic: "celery stalk" appearance. 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). Arthroscopy. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. : A Meta-Analysis. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. Seventeen females (67%) and eight males (33%) were included in the final analysis. The patient presented with extension block of the knee. National Library of Medicine -, Makino A, Pascual-Garrido C, Rolon A, Isola M, Muscolo DL. volume33, Articlenumber:26 (2021) 6. Clin Orthop Surg 10(3):307314. 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. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Average patient age was 49 (22 to 68) years. Accessed 1 Mar 2021. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. HHS Vulnerability Disclosure, Help This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. J Clin Epidemiol 62(10):10061012. 2013;15(1). A total of 313 knees in 292 patients were included. The pathogenesis remains controversial. Please enable it to take advantage of the complete set of features! It results in postoperative laxity, but rarely in frank instability. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. ACL debridement was partial in all studies except for those by Lintz et al. [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%). Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. Learn how we can help 704 views Reviewed >2 years ago Thank 2004;182(5):12837. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. The rate of simultaneous meniscectomy ranged from 13 to 44%. 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. https://doi.org/10.4103/0019-5413.101037, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligament management and functional outcome of 18 cases. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). in 1999 [1]. J Chin Med Assoc. 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. Mucoid degeneration of the anterior cruciate ligament. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. Twelve partial and 17 total resections were performed. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. (2018) Radiology. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Dietary management and various treatments Scanning and diagnostic . 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. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . sharing sensitive information, make sure youre on a federal It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. Bethesda, MD 20894, Web Policies 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. Epub 2010 May 8. Conclusions 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 . Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. Any discrepancy was resolved by the senior author. 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. 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. The author(s) read and approved the final manuscript. CAS eCollection 2022 May-Jun. Rehabilitation, orthophony, crenotherapy. You can read more if you want. Accessibility the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). 1999;81(2):304305. mucoid degeneration of acl mri. The total number of patients with symptomatic instability was 18 out of 288 (6%). 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. 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 acl symptoms. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Springer Nature. Results: Anatomopathology samples were collected in 18 cases. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. 2023 BioMed Central Ltd unless otherwise stated. Skeletal Radiology. Papadopoulou P. The celery stalk sign. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Bergin et al. PubMed 4. Therefore, indications for ACL resection must be carefully selected. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . This appearance can mimic acute or chronic interstitial partial tears of the ligament. 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. What you feel (symptoms) You feel heaviness in knee joint. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. (100%). The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. to 44% in the study of Cha et al. https://doi.org/10.1016/j.arthro.2003.11.030, Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 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. In most cases Physiopedia articles are a secondary source and so should not be used as references. Keywords: 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. This site needs JavaScript to work properly. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review, https://doi.org/10.1186/s43019-021-00110-6, https://doi.org/10.1302/0301-620X.81B2.0810304, https://doi.org/10.1007/s00167-011-1433-0, https://doi.org/10.2214/ajr.182.5.1821283, https://doi.org/10.1007/s00167-012-1991-9, https://doi.org/10.1016/j.arthro.2003.11.030, https://doi.org/10.1016/j.jclinepi.2009.06.005, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782, https://doi.org/10.1046/j.1445-2197.2003.02748.x, http://journals.sagepub.com/doi/10.1177/2325967118786930, http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, https://doi.org/10.1016/j.arthro.2008.02.004, https://doi.org/10.1016/j.jajs.2015.12.001, https://doi.org/10.4055/cios.2018.10.3.307, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 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). official website and that any information you provide is encrypted https://doi.org/10.2214/ajr.182.5.1821283, Article 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. Epub 2011 Feb 18. 2011. Privacy Risk factors Predisposing factors include the following 1: aging Accessibility Conclusion: Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. 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). The mean MINORS score was 9.5 (range 412). Am J Roentgenol 182(5):12831287. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. [Diagnosis and treatment of anterior cruciate ligament cysts]. When refering to evidence in academic writing, you should always try to reference the primary (original) source. However, symptomatic instability was not common. Would you like email updates of new search results? The extracted data were heterogeneous in terms of outcome assessment. 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. . Clipboard, Search History, and several other advanced features are temporarily unavailable. Bookshelf https://doi.org/10.1016/j.jclinepi.2009.06.005. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid 2021 Sep;50(9):1837-1843. doi: 10.1007/s00256-021-03750-7. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. report that one patient had ACL reconstruction simultaneously after the ACL debridement. Epub 2013 Aug 27. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Conclusions: Mucoid degeneration of the ACL is a clinical condition afflicting active middle-aged people without a single significant traumatic episode with a specific MRI picture. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Epub 2013 Aug 27. Fourteen knees (48%) had limited flexion, on average 97 degrees. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. AJR Am J Roentgenol. The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased signal intensity and a celery stalk appearance of intact fibers. PMC Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Skeletal Radiol. Introduction: Ligaments are very tough, fibrous tissue structures. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. All nine studies were case series; six were retrospective and three were prospective studies. Epub 2018 Apr 21. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. 2. Keywords: Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Pan African Medical Journal. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Check for errors and try again. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. Bookshelf All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. 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. Roberts CC, Towers JD, Spangehl MJ et-al. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Arthroscopy. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. Federal government websites often end in .gov or .mil. Each study was scored 02 on each question, with a global ideal score of 16. sharing sensitive information, make sure youre on a federal Unauthorized use of these marks is strictly prohibited. Indian J Orthop. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Postoperative pain relief ranged from 53.8 to 95%. Anterior Cruciate Ligament, is an important structure of the knee joint. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Mucoid degeneration itself is described as a yellow or brown substance which can be either seen through the most anterior fibers of the ACL or found by probing between them [ 19, 35] (Fig. reported on the co-existence of mucoid degeneration and ganglia of the ACL. This systematic review has some limitations. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. 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. Methods: The minimum follow-up was 3 years. PMC Individuals with mucoid degeneration 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. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact.
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