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. The minimum follow-up was 3 years. 2. "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. The https:// ensures that you are connecting to the 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. 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). Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. CAS Careers. In most cases Physiopedia articles are a secondary source and so should not be used as references. official website and that any information you provide is encrypted sharing sensitive information, make sure youre on a federal Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. 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. Mucoid degeneration of the anterior cruciate ligament. This makes it difficult to relate the improvement of symptoms to ACL debridement. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. 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). ACL ganglion cyst at arthroscopy may appear as a cystic mass with . They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. 2006;69(9):44952. [16]. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Presentation Patients usually present with nonspecific posterior knee pain with restriction of flexion. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. Papadopoulou P. The celery stalk sign. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. On clinical examination, the active range of motion showed a flexion deficit. What is Anterior Cruciate Ligament Mucoid Degeneration? Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 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. (B) Partial resection, MeSH Disclaimer. government site. 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. . Four studies reported only postoperative scores, which were comparable to those in other studies. Orthop Traumatol Surg Res. 8600 Rockville Pike . 2008 Jun;24(6):642-9. doi: 10.1016/j.arthro.2008.02.004. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. (2018) Radiology. 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). Hypothesis: 5. Careers. Morice et al. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. See this image and copyright information in PMC. CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. Careers. The site is secure. Postoperative pain relief ranged from 53.8 to 95%. Rehabilitation, orthophony, crenotherapy. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. Bethesda, MD 20894, Web Policies 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. Arthroscopic debridement of the ACL resulted in good pain relief and improved range of movement in all studies, with postoperative improvement in the knee scores. Mucoid degeneration of the anterior cruciate ligament. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. A 48-year-old-male patient presented with knee pain and limitation of motion. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Arch Orthop Trauma Surg. Bergin et al. (61years), which was the largest study and represented more than one third of the total patients included in this review. They respond well to a judicious arthroscopic release of the ACL with notchplasty. sharing sensitive information, make sure youre on a federal Pandey, Vivek et al. https://doi.org/10.1046/j.1445-2197.2003.02748.x, Ekhtiari S, Horner NS, Bedi A, Ayeni OR, Khan M. The learning curve for the Latarjet procedure: a systematic review. 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. official website and that any information you provide is encrypted Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. 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. International Journal of Orthopaedics. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. 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). GG and AM interpreted the results and reviewed the manuscript. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. PubMed Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Dietary management and various treatments Scanning and diagnostic . 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. Postoperative recovery was four weeks on average. (100%). Orthopedics; anterior cruciate ligament; arthoscopy. #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. ANZ J Surg 73(9):712716. Knee Surgery & Related Research To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Please enable it to take advantage of the complete set of features! National Library of Medicine 2001;30(6):312315. 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. [17] do not mention whether any patients underwent biopsy (Table 3). Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. Other theories include Degenerative theory- MD could occur due to ageing.[3]. What is myxoid degeneration treatment? Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. and transmitted securely. https://doi.org/10.1007/s00167-011-1433-0, Article official website and that any information you provide is encrypted Chudasama et al. Disclaimer. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Indian J Orthop 46(5):561565. Ligaments hold our bones together and allow us to bend, twist, pivot and rapidly accelerate and decelerate and yet maintain the stability of our joints. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Anterior cruciate ligament mucoid degeneration. Unauthorized use of these marks is strictly prohibited. Federal government websites often end in .gov or .mil. Keywords: -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Therefore, indications for ACL resection must be carefully selected. 6. Each study was scored 02 on each question, with a global ideal score of 16. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. The patient presented with extension block of the knee. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. There was more than 20% loss to follow up in the study of Kim et al., while the three prospective studies had no loss to follow up [13, 14, 18]. Truncation means that the . Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. All nine studies were case series; six were retrospective and three were prospective studies. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. 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). 1173185. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. The rate of simultaneous meniscectomy ranged from 13 to 44%. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. Characteristic: "celery stalk" appearance. Google Scholar, Chudasama CH, Chudasama VC, Prabhakar MM (2012) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. When refering to evidence in academic writing, you should always try to reference the primary (original) source. ACL tears don't heal as such. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Would you like email updates of new search results? Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. 2007;90(3):1923. An official website of the United States government. Average postoperative International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were 71.2 (42.5 to 92.0) and 78.2 (26.4 to 99). . eCollection 2021. 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. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee All patients (100%, n=11) reported a good to very good surgery satisfaction. eCollection 2022 May-Jun. An official website of the United States government. https://www.physio-pedia.com/index.php?title=Anterior_Cruciate_Ligament_(ACL)_Mucoid_Degeneration&oldid=253974, Difficulty in climbing stairs, cross-leg sitting, squatting, Primary condition- Osteoarthritis, degenerative menisci, meniscal tear, Impingement of the soft tissue in the vicinity. [6], in 62% of patients (18 of 29) in the study of Lintz et al. 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. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. 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. Rajani AM, Shah UA, Mittal ARS, Gupta S, Garg R, Punamiya M. Knee Surg Relat Res. An official website of the United States government. The mean age at the time of surgery was 57 years (range, 31 to 78 years). The clinical presentation is one of posterior pain with limited flexion. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. Knee Surg Sports Traumatol Arthrosc. 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. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Epub 2010 May 8. The site is secure. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Sagittal T2-weighted MRI view showing intact anterior, Fig. -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. The cause is not really known, but patients usually do not complain of instability. This is a rare pathological condition, in which, there is increased signal from within the ligament. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. 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 . what causes mucoid degeneration of acl. mucoid degeneration of acl mri. W B Saunders Co. (2005) ISBN:0721602703. in 1999 [1]. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. 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). 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Skelet Radiol 30(6):312315. The author(s) read and approved the final manuscript. 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. (A) Bulging of the hypertrophied anterior cruciate ligament. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Pain was posterior in 23 knees (80%). PubMed Central sharing sensitive information, make sure youre on a federal Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. (10%) and highest in the study of Ventura et al. IV (retrospective cohort study). Epub 2021 Mar 8. government site. Knee Surg Sports Traumatol Arthrosc. 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 No treatment is usually required. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. Resnick D, Kransdorf MJ. https://doi.org/10.1007/s00167-012-1991-9, McIntyre J, Moelleken S, Tirman P (2001) Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Patients will . The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. Mumbai, Maharashtra, India. Level of Evidence: Level IV. 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. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. [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%). -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid Preoperative magnetic resonance imaging (MRI), Fig. Postoperative clinical laxity was common, however, symptomatic instability was not. Knee. None of the studies was a randomised controlled trial and none had a control group. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. Radiology. Tamer Sweed. 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. Provided by the Springer Nature SharedIt content-sharing initiative. It is a chronic degenerative change of a bulky ACL that may lead to notch impingement syndrome in the absence of instability symptoms and significant trauma history [ 1, 2, 3, 4 ]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. https://doi.org/10.1302/0301-620X.81B2.0810304, Article All nine studies included patients with symptomatic MDACL confirmed by MRI (Table3). Epub 2013 Aug 27. Three reviewers (an experienced librarian and two of the authors) independently searched these databases. Privacy Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Cite this article. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. The authors declare that they have no competing interests. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. Indian J Orthop. Khanna et al. Patient having mucoid degeneration of ACL seeks multiple orthopedic consultation and most of the time treating orthopedican miss its diagnosis either because of lack of experience or rare cause of pain unless doctor sought magnetic resonance imaging (MRI) of knee. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). See this image and copyright information in PMC. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. Arthroscopic findings. A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. This site needs JavaScript to work properly. 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. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. A total of 313 knees in 292 patients were included in the nine studies. Patients and methods: 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. Besides, the patient may also have trouble in moving. Hide glossary Glossary. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. This study concerns complete ACL resec 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. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. 8600 Rockville Pike Advanced MR imaging of the cruciate ligaments. 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. Online ahead of print. Knee Surg Sports Traumatol Arthrosc. It may lead to knee pain. as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. The mean age of patients ranged from 31 to 78years. However, in most studies a proportion of patients simultaneously underwent other arthroscopic procedures for associated pathological knee conditions (44% meniscectomies in the study of Cha et al.). Case report: Accessibility Therefore, indications for ACL resection must be carefully selected. 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. Skeletal Radiology. https://doi.org/10.1016/j.jclinepi.2009.06.005. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. The origin of MDACL may be degenerative or traumatic. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. -, Hodler J, Haghighi P, Trudell D, Resnick D. The cruciate ligaments of the knee: Correlation between MR appearance and gross and histologic findings in cadaveric specimens. Cho SD, Youm YS, Lee CC et-al. PubMed ACL debridement was partial in all studies except for those by Lintz et al. The pathogenesis remains controversial. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. This site needs JavaScript to work properly. Bethesda, MD 20894, Web Policies It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. 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. 2001;17(9):E37. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. Anterior Cruciate Ligament, is an important structure of the knee joint. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. 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.
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