2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. The purpose of this study was to investigate the outcome of management of MDACL by performing a systematic review of methods of treatment that have been reported. Clipboard, Search History, and several other advanced features are temporarily unavailable. The .gov means its official. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. Score: 4.7/5 (45 votes) . It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. volume33, Articlenumber:26 (2021) The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. The https:// ensures that you are connecting to the JBR-BTR. Skeletal Radiol. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. PMC Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Mucoid degeneration of the anterior cruciate ligament. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. 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). Please enable it to take advantage of the complete set of features! First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. Bookshelf Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Bergin D, Morrison WB, Carrino JA et-al. 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). 2011 Jun;25(6):650-2. Chudasama CH, Chudasama VC, Prabhakar MM. Bethesda, MD 20894, Web Policies Advanced MR imaging of the cruciate ligaments. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Mucoid degeneration of the anterior cruciate ligament. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. 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. For non-comparative studies, this consists of eight questions. Arthroscopic treatment of mucoid hypertrophy 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. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. This study concerns complete ACL resec Twelve partial and 17 total resections were performed. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. J Knee Surg. in 1999 [1]. Orthopedics; anterior cruciate ligament; arthoscopy. and transmitted securely. in 1999 [ 1 ]. PubMedGoogle Scholar. Accessibility Knee Surg Sports Traumatol Arthrosc. 2008 Jun;24(6):642-9. doi: 10.1016/j.arthro.2008.02.004. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Disclaimer. ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. 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. https://doi.org/10.4103/0019-5413.128765, Article 2018;4(4):875-80. 2011 Mar;25(3):262-5. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. -, Makino A, Pascual-Garrido C, Rolon A, Isola M, Muscolo DL. Cookies policy. Knee Surg Sports Traumatol Arthrosc. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . A long duration of non-specific knee pain in a patient should be evaluated with MRI. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Arthroscopic findings. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. Copyright 2010 Elsevier Masson SAS. 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. Knee Surg & Relat Res 33, 26 (2021). Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. -, 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. Sep 2017 - Feb 20186 months. and transmitted securely. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782. Introduction: The site is secure. This site needs JavaScript to work properly. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. 2. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. See this image and copyright information in PMC. 2009. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Bergin et al. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. All patients (100%, n=11) reported a good to very good surgery satisfaction. Mucinous material within the substance of ACL produces pain and limited motion in the knee. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. AJR Am J Roentgenol. (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). Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. National Library of Medicine Terms and Conditions, 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. 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. 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. sharing sensitive information, make sure youre on a federal and Ventura et al. Arthroscopy. The total number of patients with symptomatic instability was 18 out of 288 (6%). Unauthorized use of these marks is strictly prohibited. 1992;159(2):35760. TS designed the project, literature search and wrote the manuscript. A 48-year-old-male patient presented with knee pain and limitation of motion. Physical Therapy. and transmitted securely. Rajani AM, Shah UA, Mittal ARS, Gupta S, Garg R, Punamiya M. Knee Surg Relat Res. Other theories include Degenerative theory- MD could occur due to ageing.[3]. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 8600 Rockville Pike Arch Orthop Trauma Surg. Unable to load your collection due to an error, Unable to load your delegates due to an error. The retrospective study by Kim 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. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. All nine studies were case series; six were retrospective and three were prospective studies. 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 proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. official website and that any information you provide is encrypted [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. Introduction: . Glossary of terms for musculoskeletal radiology. Epub 2018 Aug 22. PubMed Central 2. Symptomatic instability was highest in the study of Lintz et al. Generally, we know little about this condition. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. A total of 313 knees in 292 patients were included. 1. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. 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. . Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Individuals with mucoid degeneration of the ACL were excluded. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Physiotherapy. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. https://doi.org/10.1007/s00167-011-1433-0, Article Reeducation. eCollection 2022 May-Jun. 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. 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 debridement of the ACL resulted in good pain relief and improved range of movement in all studies, with postoperative improvement in the knee scores. Rehabilitation, orthophony, crenotherapy. However, symptomatic instability was not common. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Risk factors Predisposing factors include the following 1: aging 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. The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. 2013;15(1). 5. Sagittal T2-weighted MRI view showing intact anterior, Fig. The site is secure. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The presence of intraligamentous mucoid degeneration in the ACL is demonstrated as a source of knee pain without instability and partial ACL debridement did not preclude adequate knee stability. (100%). Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. 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. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. https://doi.org/10.1016/j.arthro.2008.02.004, Morice A, Coupry A, Lintz F, Robert H (2013) Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Bookshelf 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. [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%). Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Read More Created for people with ongoing healthcare needs but benefits everyone. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Arthroscopy. Conclusions. 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. J Sports Med Phys Fitness 48(4):483487, PubMed 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. 3. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Knee Surgery, Sports Traumatology, Arthroscopy. -. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. The extracted data were assessed for meta-analysis. FOIA Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. MeSH Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. 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). 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 . Unable to load your collection due to an error, Unable to load your delegates due to an error. 2011. The https:// ensures that you are connecting to the AJR Am J Roentgenol. MeSH Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. 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. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. sharing sensitive information, make sure youre on a federal sharing sensitive information, make sure youre on a federal Knee Surg Sports Traumatol Arthrosc 19(8):13261333. The patient presented with extension block of the knee. 8600 Rockville Pike Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The mean MINORS score was 9.5 out of 16 (412). You can read more if you want. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Methods: When refering to evidence in academic writing, you should always try to reference the primary (original) source. Dietary management and various treatments Scanning and diagnostic . Questions just answered: mucoid degeneration of acl physiotherapy. just over two decades ago [], the interest in this condition has quickly gathered pace in the orthopaedic community.Little is known about this condition that affects 1.8-5.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Google Scholar, Chudasama CH, Chudasama VC, Prabhakar MM (2012) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Methods: The minimum follow-up was 3 years. as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. reported on the co-existence of mucoid degeneration and ganglia of the ACL. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. 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. . 2011 Aug 1;19(8):1326-33. Federal government websites often end in .gov or .mil. Download Citation | On Feb 1, 2023, O.R. statement and 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. -, Fealy S, Kenter K, Dines JS, Warren RF. It results in postoperative laxity, but rarely in frank instability. [17] do not mention whether any patients underwent biopsy (Table 3). Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. in 1999 [1]. https://doi.org/10.1016/j.jajs.2015.12.001, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J (2018) Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. The mean follow up ranged from 13 to 72months. Springer Nature. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. Skelet Radiol 30(6):312315. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Epub 2021 Nov 24. Epub 2008 Apr 18. This site needs JavaScript to work properly. MM and A performed the literature search, and data analysis. Epub 2011 Feb 18. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. The inclusion criteria for this study were (1) studies including symptomatic patients with mucoid degeneration of the ACL, (2) studies of 10 or more patients, (3) a minimum of 6months follow up and (4) patients treated conservatively or surgically (arthroscopic debridement with or without simultaneous ACL reconstruction). Epub 2011 Feb 18. What causes mucoid degeneration of ACL? Please enable it to take advantage of the complete set of features! Orthop Traumatol Surg Res 99(6):693697, Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS (2016) Mucoid degeneration of the anterior cruciate ligament: partial arthroscopic debridement and outcomes. CAS 2011;19(3):408411. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The rate of association between meniscal tears and MDACL ranged from 9 to 96%. However, the authors did not report whether there were any other patients with symptomatic instability. NCI CPTC Antibody Characterization Program. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. Indian J Orthop 48(2):197202. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. All rights reserved. did not report on this. PubMed . Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. Mucoid degeneration of A C L is more common and literature has also reported many cases, but for PCL only few cases have been reported in English literature. [6], in 62% of patients (18 of 29) in the study of Lintz et al. Arthroscopic debridement may help relieve the anterior knee pain. 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. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. 2. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. The pathogenesis remains controversial. PMC The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). official website and that any information you provide is encrypted Manage cookies/Do not sell my data we use in the preference centre. 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. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). At the time the article was created Frank Gaillard had no recorded disclosures. Orthopaedics & Traumatology: Surgery & Research. 6. 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. Fig. Cho SD, Youm YS, Lee CC et-al. 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.
