The minimum follow-up was 3 years. Reeducation. Indian J Orthop 46(5):561565. . Tamer Sweed. 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. Papadopoulou P. The celery stalk sign. PMC Cho SD, Youm YS, Lee CC et-al. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. Therefore, indications for ACL resection must be carefully selected. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. official website and that any information you provide is encrypted However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. Epub 2011 Feb 18. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. The origin of MDACL may be degenerative or traumatic. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. 2004;182 (5): 1283-7. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. MDACL is differentiated from synovial cysts of the anterior cruciate ligament (ACL) where, in MDACL, mucoid tissue intermingles within ACL fibres and is not contained within a cyst [3]. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Google Scholar, Chudasama CH, Chudasama VC, Prabhakar MM (2012) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. Clipboard, Search History, and several other advanced features are temporarily unavailable. Bergin D, Morrison WB, Carrino JA et-al. Disclaimer. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Knee Surg Sports Traumatol Arthrosc. Bergin et al. Conclusions: ACL tears don't heal as such. Any discrepancy was resolved by the senior author. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Unauthorized use of these marks is strictly prohibited. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Check for errors and try again. Epub 2013 Aug 27. Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was debrided. Terms and Conditions, Eight studies reported postoperative instability. 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). #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. . 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. Radiologic findings associated with mucoid degeneration of 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%). I get PT and acupuncture, have had several epidural injections, and am trying hard to avoid osteoporosis meds (was on bisphosphonates for many years many years ago) as well as spinal fusion. Before 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. Pain was posterior in 23 knees (80%). in 1999 [ 1 ]. Postoperative pain relief ranged from 53.8 to 95%. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Preoperative magnetic resonance imaging (MRI) scan. Morice et al. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. Hypothesis: Physiotherapy. Preoperative and postoperative results of eleven patient were compared. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. Unable to process the form. PMC J Knee Surg. 2. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. [17] do not mention whether any patients underwent biopsy (Table 3). Physiotherapy. Cookies policy. (100%). The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Bone and joint imaging. Privacy See this image and copyright information in PMC. The extracted data were assessed for meta-analysis. [16]. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. Methods: Sep 2017 - Feb 20186 months. 2011 Aug 1;19(8):1326-33. Unable to load your collection due to an error, Unable to load your delegates due to an error. have described the following MRI criteria [4]: (1) high signal intensity in the T1 and T2 sequences, (2) increased ACL volume and (3) continuous fibres of ACL shown in the T2 sequence. reported on the co-existence of mucoid degeneration and ganglia of the ACL. The .gov means its official. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. (Table 3). in 1999 [1]. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. Physical Therapy. PMC Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. 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 ]. This systematic review has some limitations. Mucoid cystic degeneration of the cruciate ligament. 2013;15(1). 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]. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 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. See this image and copyright information in PMC. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. 5. Advanced MR imaging of the cruciate ligaments. 2011. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 2018;4(4):875-80. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. 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). statement and 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. 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. Patients will . Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The mean follow up ranged from 13 to 72months. The rate of simultaneous meniscectomy ranged from 13 to 44%. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. Three reviewers (an experienced librarian and two of the authors) independently searched these databases. Cite this article. government site. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Mucoid degeneration of the anterior cruciate ligament. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Second, methodological quality assessment showed that three studies had low methodological quality. Copyright 2010 Elsevier Masson SAS. what causes mucoid degeneration of acl. The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. Level of evidence: Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Careers. Rehabilitation, speech therapy, crenotherapy. Am J Roentgenol 182(5):12831287. W B Saunders Co. (2005) ISBN:0721602703. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Pandey, Vivek et al. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. J Sports Med Phys Fitness 48(4):483487, PubMed 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. This study concerns complete ACL resec 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. PubMed Central 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. -, Fealy S, Kenter K, Dines JS, Warren RF. By using this website, you agree to our These appearances must be differentiated from mucoid degeneration of the intact ACL. What is myxoid degeneration treatment? In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. PubMedGoogle Scholar. HHS Vulnerability Disclosure, Help Knee Surgery, Sports Traumatology, Arthroscopy. 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. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Coronal proton density-weighted magnetic resonance, Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate, Sagittal proton density-weighted magnetic resonance, Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased, Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate, Pre-debridement arthroscopic view showing yellowish. Chudasama et al. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. 2004;182(5):12837. Arthroscopy. This site needs JavaScript to work properly. 1. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. You can read more if you want. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. 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. There was strong association with chondral lesions and meniscal tears. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Along with that, it also controls the internal rotation. Skeletal Radiology. J Chin Med Assoc. Orthopaedics & Traumatology: Surgery & Research. 2011;19(3):408411. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Bookshelf It results in postoperative laxity, but rarely in frank instability. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. 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. 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. Bergin et al. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. J Arthrosc Joint Surg 3(1):2833. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Answer (1 of 2): Most of the time mucoid degenrative changes in the ACL does not cause any problemonly if u have sign of ACL instability or the bending of the knee is reduced you may need a arthroscopic evaluation usually u may skip without ACL reconstruction but some of us will need AcL recons. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. PROSPERO. The ligament is mainly responsible for restraining anterior translation of knee. Arthroscopic findings. volume33, Articlenumber:26 (2021) 2010 Jun 1;96(4):400-6. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. -. Before On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. 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. in 1999 [ 1 ]. 6. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. 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. AJR Am J Roentgenol. 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). For non-comparative studies, this consists of eight questions. The quality of methodology was excellent in one study, good in five studies, low in two studies and very low in one study (Tables 1 and 2). Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Arthroscopy. An official website of the United States government. At the time the article was last revised Dai Roberts had no recorded disclosures. 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. Rajani AM, Shah UA, Mittal ARS, Gupta S, Garg R, Punamiya M. Knee Surg Relat Res. Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. Knee Surg Sports Traumatol Arthrosc. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Keywords: For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . Methods: The minimum follow-up was 3 years. Mucoid degeneration of the anterior cruciate ligament: a case report. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. Mucoid degeneration of both ACL and PCL. Arthroscopic findings. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 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. The site is secure. 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 (61years), which was the largest study and represented more than one third of the total patients included in this review. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 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. mucoid degeneration of acl mri. (B) Partial resection, MeSH Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). 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. 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. . PMC eCollection 2021. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. Part of Sagittal T2-weighted MRI view showing intact anterior, Fig. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH When refering to evidence in academic writing, you should always try to reference the primary (original) source. https://doi.org/10.1186/s43019-021-00110-6, DOI: https://doi.org/10.1186/s43019-021-00110-6. J Bone Joint Surg Br. Provided by the Springer Nature SharedIt content-sharing initiative. sharing sensitive information, make sure youre on a federal 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid degeneration of the anterior cruciate ligament (ACL) is regarded as a degenerative change in the ligament, which is clinically presented with pain on full extension or flexion in the middle-aged population. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Patients and methods: Categories were determined in accordance with the study of Ekhtiari et al. Open Grey database was searched for grey literature using the same keywords. Disclaimer. official website and that any information you provide is encrypted Accessibility Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. The mean MINORS score was 9.5 (range 412). Epub 2018 Apr 21. In most cases Physiopedia articles are a secondary source and so should not be used as references. 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. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. Orthopedics; anterior cruciate ligament; arthoscopy. 8600 Rockville Pike 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Anterior cruciate ligament mucoid degeneration. Eight studies showed postoperative improvement in range of motion, whereas Khanna et al.

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