Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Knee Surgery & Related Research Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. Arthroscopy. . Bergin et al. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782. Twelve partial and 17 total resections were performed. The clinical presentation is one of posterior pain with limited flexion. The patient presented with extension block of the knee. Part of The .gov means its official. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. 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). It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. A total of 313 knees in 292 patients were included. Epub 2011 Feb 18. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Cho SD, Youm YS, Lee CC et-al. 2011. Careers. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. 5. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. The .gov means its official. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. See this image and copyright information in PMC. Therefore, indications for ACL resection must be carefully selected. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. 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. The mean MINORS score was 9.5 out of 16 (412). Advanced MR imaging of the cruciate ligaments. Unauthorized use of these marks is strictly prohibited. MRI - Interstitial ACL tear With Mild knee joint effusion ,No evidence of discontinuation of fibre Can Interstitial ACL tear heal without surgery Asked for Male, 22 Years 78 Views v Dr. Abhishek Kaushik Joint Replacement Surgeon | Delhi 1/1 people found this helpful Hi. Mumbai, Maharashtra, India. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. 2018;4(4):875-80. Clipboard, Search History, and several other advanced features are temporarily unavailable. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Open Grey database was searched for grey literature using the same keywords. Knee Surg Sports Traumatol Arthrosc. Mucoid degeneration of the anterior cruciate ligament. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Skeletal Radiol. Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. official website and that any information you provide is encrypted CAS Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. sharing sensitive information, make sure youre on a federal . There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH 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. Clin Orthop Surg 10(3):307314. Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. 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. Arthroscopy. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. Arch Orthop Trauma Surg. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Federal government websites often end in .gov or .mil. PMC Knee Surg Sports Traumatol Arthrosc 21(3):658663. Therefore, indications for ACL resection must be carefully selected. [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. 6. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . JBR-BTR. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. The cause is not really known, but patients usually do not complain of instability. government site. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. 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. 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. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Instrumental treatment. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. The mean follow up ranged from 13 to 72months. -, Fealy S, Kenter K, Dines JS, Warren RF. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. Bergin et al. ACL tears don't heal as such. California Privacy Statement, MeSH Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. MeSH Symptomatic instability was highest in the study of Lintz et al. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. Unable to load your collection due to an error, Unable to load your delegates due to an error. Symptomatic ACL mucoid degeneration in middle-age athletes. PMC PMC Accessed 1 Mar 2021. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. You can read more if you want. -Evaluated and planned treatment protocol in accordance with physician. Skelet Radiol 30(6):312315. 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 eCollection 2021. https://doi.org/10.2214/ajr.182.5.1821283, Article Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Epub 2021 Mar 8. Keywords: At the time the article was created Frank Gaillard had no recorded disclosures. PROSPERO. 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. J Arthrosc Joint Surg 3(1):2833. 2007;245 (3): 916-7. 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. Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). The origin of MDACL may be degenerative or traumatic. Indian J Orthop. Preoperative magnetic resonance imaging (MRI) scan. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. PMC Epub 2018 Jan 2. Signal intensity of the anteromedial bundle (AMB) or posterolateral bundle (PLB) graft standardized to the intensity of the PCL was defined as signal intensity ratio (SIR). did not report on this. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Orthopedics; anterior cruciate ligament; arthoscopy. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. 2023 BioMed Central Ltd unless otherwise stated. W B Saunders Co. (2005) ISBN:0721602703. Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. The appearance can mimic acute or chronic interstitial partial tears of the ACL. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. 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. [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%). Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. This may support the theory that it is a degenerative process. bling. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. 2007;15 (1): 73-86. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Arthroscopic findings. what causes mucoid degeneration of acl. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. The mean MINORS score was 9.5 (range 412). When refering to evidence in academic writing, you should always try to reference the primary (original) source. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Radiology. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. GG and AM interpreted the results and reviewed the manuscript. That is usually the journal article where the information was first stated. Individuals with mucoid degeneration of the ACL were excluded. Accessibility 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. Federal government websites often end in .gov or .mil. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 8600 Rockville Pike Keywords: This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. The primary intervention was arthroscopic ACL debridement in eight studies; this was combined with notchplasty in cases of impingement with the lateral wall of the notch in five studies [6, 14, 16,17,18] (Table 3). Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. 8600 Rockville Pike Read More Created for people with ongoing healthcare needs but benefits everyone. 8600 Rockville Pike eCollection 2022 May-Jun. Rehabilitation, orthophony, crenotherapy. Tamer Sweed. Careers. Method. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 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]. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The site is secure. 2009. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. TS designed the project, literature search and wrote the manuscript. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. . Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was debrided. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Knee Surg Sports Traumatol Arthrosc. (61years), which was the largest study and represented more than one third of the total patients included in this review. Epub 2013 Aug 27. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Imaging: Plain radiographs In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). (A) Bulging of, Fig. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. in 1999 [1]. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. 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. Arthroscopy. 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). Score: 4.7/5 (45 votes) . However, the authors did not report whether there were any other patients with symptomatic instability. 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) 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). CAS 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. AJR Am J Roentgenol. What is Anterior Cruciate Ligament Mucoid Degeneration? Arch Orthop Trauma Surg. Anterior knee pain is the more common complaint. 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 . Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. Orthop Traumatol Surg Res. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. However, MDACL is asymptomatic in most patients. Sweed, T., Mussa, M., El-Bakoury, A. et al. 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. 1). An official website of the United States government. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Symptoms included limited range of motion (ROM) and posterior knee pain. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. By using this website, you agree to our Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Privacy Online ahead of print. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. The appearance can mimic acute or chronic interstitial partial tears of the ACL. An official website of the United States government. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. Mucoid degeneration of the anterior cruciate ligament: a case report. A total of 313 knees in 292 patients were included in the nine studies. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. At the time the article was last revised Dai Roberts had no recorded disclosures. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. 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. Arthroscopic findings. 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). Indian J Orthop 46(5):561565. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. None of the studies was a randomised controlled trial and none had a control group. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. 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 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. 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. Only nine studies met our inclusion criteria and they were all case series. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. FOIA Cite this article. Terms and Conditions, Chudasama et al. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. mucoid degeneration acl symptoms. Online ahead of print. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. 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. See this image and copyright information in PMC. 2011. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Disclaimer. Any discrepancy was resolved by the senior author. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. 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. Background: Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. 2011 Aug 1;19(8):1326-33. These appearances must be differentiated from mucoid degeneration of the intact ACL. National Library of Medicine MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. Here are the search results of the thread mucoid degeneration of acl treatment from Bing.