Bookshelf 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. Mucoid degeneration of the anterior cruciate ligament. It results in postoperative laxity, but rarely in frank instability. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Resnick D, Kransdorf MJ. 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. National Library of Medicine Along with that, it also controls the internal rotation. All patients (100%, n=11) reported a good to very good surgery satisfaction. AJR Am J Roentgenol. Initially, partial weightbearing is allowed. 2 ). 2010 Jun 1;96(4):400-6. government site. California Privacy Statement, Orthop Traumatol Surg Res. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Conclusions: Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. [Diagnosis and treatment of anterior cruciate ligament cysts]. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Fig. 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. This may support the theory that it is a degenerative process. 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 aetiology of MDACL is not fully understood, hence, there are multiple theories on this. The mean age of patients ranged from 31 to 78years. Careers. Skelet Radiol 30(6):312315. The rate of simultaneous meniscectomy ranged from 13 to 44%. 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. The .gov means its official. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Epub 2018 Jun 13. Other theories include Degenerative theory- MD could occur due to ageing.[3]. 2009. in this condition your acl (anterior cruciate ligament) filled with jelly like material and it thickened so space in intercondylar resion of knee joint is reduced. HHS Vulnerability Disclosure, Help Hide glossary Glossary. CAS report that one patient had ACL reconstruction simultaneously after the ACL debridement. Sweed, T., Mussa, M., El-Bakoury, A. et al. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first described in the literature in 1999.1 Since then, MD-ACL has been recognized as a pathology present on between 0.7% and 5.3% of magnetic resonance images performed for knee pain.2 MD-ACL is thought to be part of a spectrum of ACL disease that can range from ganglion cysts to MD.3 MD-ACL can either be primary (idiopathic . Epub 2011 Feb 18. Epub 2011 Feb 18. However, the authors did not report whether there were any other patients with symptomatic instability. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Accessibility sharing sensitive information, make sure youre on a federal The mean follow up ranged from 13 to 72months. Unauthorized use of these marks is strictly prohibited. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Bergin et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Online ahead of print. Sep 2017 - Feb 20186 months. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. Eight studies reported postoperative instability. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. Four studies reported only postoperative scores, which were comparable to those in other studies. MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. J Arthrosc Joint Surg 3(1):2833. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. eCollection 2021. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. sharing sensitive information, make sure youre on a federal 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. Symptomatic instability was highest in the study of Lintz et al. Postoperative pain relief was reported in seven studies. Therefore, indications for ACL resection must be carefully selected. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate 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%). 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. AJR Am J Roentgenol. This site needs JavaScript to work properly. Indian J Orthop. 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. 2. At the time the article was created Frank Gaillard had no recorded disclosures. An official website of the United States government. 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.). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. did not report on this. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. 2011 Jun;25(6):650-2. This makes it difficult to relate the improvement of symptoms to ACL debridement. 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. It results in postoperative laxity, but rarely in frank instability. First, our literature search revealed a heterogeneous group of studies dominated by case reports and case series, with no randomised controlled trials. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. 3. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. It is a chronic degenerative change of a bulky ACL that may lead to notch . The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. This site needs JavaScript to work properly. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. 8600 Rockville Pike in 1999 [1]. ADVERTISEMENT: Supporters see fewer/no ads. Orthopaedics & Traumatology: Surgery & Research. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. Disclaimer. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. All nine studies were case series; six were retrospective and three were prospective studies. 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. reported on the co-existence of mucoid degeneration and ganglia of the ACL. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Online ahead of print. sharing sensitive information, make sure youre on a federal 2011 Mar;25(3):262-5. Arthroscopy. There is no consensus on treatment and evidence is scarce. Methods: Level of Evidence: Level IV. Knee Surg Sports Traumatol Arthrosc. CAS Case report: -. Please enable it to take advantage of the complete set of features! 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). Two patients uderwent secondary ligamentoplasty. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. 2011. Magn Reson Imaging Clin N Am. 2. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. Glossary of terms for musculoskeletal radiology. Please enable it to take advantage of the complete set of features! This study concerns complete ACL resec Conclusion: Epub 2013 Aug 27. 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]. 8600 Rockville Pike Indian J Orthop 48(2):197202. Patients and methods: official website and that any information you provide is encrypted 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. 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. 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). No treatment is usually required. 1). bling. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. J Sports Med Phys Fitness 48(4):483487, PubMed 2023 BioMed Central Ltd unless otherwise stated. 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). 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. The site is secure. A 48-year-old-male patient presented with knee pain and limitation of motion. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Accessibility In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Fourteen knees (48%) had limited flexion, on average 97 degrees. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. Bergin et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. The mean age at the time of surgery was 57 years (range, 31 to 78 years). Copyright 2010 Elsevier Masson SAS. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. [17] do not mention whether any patients underwent biopsy (Table 3). 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. 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. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). in 1999 [1]. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. Intact fibers are best seen on T2WI. Epub 2010 May 8. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. 4. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. 2013;15(1). Skeletal Radiol. 2007;15 (1): 73-86. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Bookshelf had the largest number of patients (91) with a mean age of 61 years, which was the oldest study population amongst the nine studies [16]. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. 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. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. PROSPERO. Federal government websites often end in .gov or .mil. Sagittal T2-weighted MRI view showing intact anterior, Fig. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. (A) Bulging of, Fig. Knee Surg Sports Traumatol Arthrosc. Before 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. National Library of Medicine Mucoid degeneration of ACL. The anterior cruciate ligament (ACL) is an important ligament in the knee. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. 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 origin of MDACL may be degenerative or traumatic. 2007;90(3):1923. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Knee Surg Sports Traumatol Arthrosc. 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 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. The mean follow up ranged from 13 to 72months. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Arthroscopy. 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. MeSH 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. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. 1 Its prevalence in magnetic resonance imaging (MRI) is 1.8-5.3%, but not all lesions are symptomatic.2, 3 It is characterized by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the 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. Privacy 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. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Unauthorized use of these marks is strictly prohibited. J Bone Joint Surg Br. The success of treatment for MDACL and the subsequent risk of instability is not known. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. (61years), which was the largest study and represented more than one third of the total patients included in this review. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. [16]. Papadopoulou P. The celery stalk sign. FOIA Introduction: The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Rehabilitation, orthophony, crenotherapy. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. official website and that any information you provide is encrypted Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Clin Orthop Surg 10(3):307314. Rehabilitation, speech therapy, crenotherapy. What you feel (symptoms) You feel heaviness in knee joint. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Careers. Any discrepancy was resolved by the senior author. 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. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. Knee Surgery & Related Research Accessibility The https:// ensures that you are connecting to the reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. 2001;30(6):312315. 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. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Manage cookies/Do not sell my data we use in the preference centre. Anterior knee pain is the more common complaint. 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. Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon non-traumatic cause of knee pain and motion restriction, typically seen in a middle-aged population. On clinical examination, the active range of motion showed a flexion deficit. Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was debrided. 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. Mucoid degeneration of the ACL is a rare cause of knee pain.1-8) This lesion of the ACL was first reported by Kumar et al.3) in 1999. The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. Bethesda, MD 20894, Web Policies Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. Keywords: All nine studies assessed the outcome of arthroscopic debridement of MDACL. Before 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]. MeSH CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. . Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Method. (B) Partial resection, MeSH Open Grey database was searched for grey literature using the same keywords. 1992;159(2):35760. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. A total of 313 knees in 292 patients were included in the nine studies.
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