Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. PROSPERO. -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Ventura et al. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. 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. [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. Online ahead of print. Reeducation. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Three reviewers (an experienced librarian and two of the authors) independently searched these databases. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. CAS Bookshelf This site needs JavaScript to work properly. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. What is Anterior Cruciate Ligament Mucoid Degeneration? Average improvement in flexion was 21.5 degrees (0 to 60 degrees). At the time the article was created Frank Gaillard had no recorded disclosures. J Bone Joint Surg Br. In most cases Physiopedia articles are a secondary source and so should not be used as references. 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. Morice et al. The .gov means its official. [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. 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. Epub 2013 Aug 27. 8600 Rockville Pike 2. Arthroscopy 24(6):642649. reported on the co-existence of mucoid degeneration and ganglia of the ACL. Would you like email updates of new search results? Knee Surg Sports Traumatol Arthrosc. 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. 1992;159(2):35760. The clinical presentation is one of posterior pain with limited flexion. Accessibility FOIA Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. official website and that any information you provide is encrypted Roberts CC, Towers JD, Spangehl MJ et-al. 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. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. 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. A 48-year-old-male patient presented with knee pain and limitation of motion. government site. Online ahead of print. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. Knee Surg Sports Traumatol Arthrosc. Please enable it to take advantage of the complete set of features! ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Physiotherapy. ANZ J Surg 73(9):712716. 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). Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2001;17(9):E37. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. (B) Partial resection, MeSH No reconstruction was performed at the same time. NCI CPTC Antibody Characterization Program. Along with that, it also controls the internal rotation. 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. 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. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. 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. Please enable it to take advantage of the complete set of features! as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. [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%). Individuals with mucoid degeneration of the ACL were excluded. National Library of Medicine Rehabilitation, speech therapy, crenotherapy. Generally, we know little about this condition. Two patients uderwent secondary ligamentoplasty. HHS Vulnerability Disclosure, Help For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Clin Orthop Surg 10(3):307314. The site is secure. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. J Bone Joint Surg Ser B 81(2):304305. 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. https://doi.org/10.1007/s00167-011-1433-0, Article 2007;90(3):1923. The need for simultaneous or delayed ACL reconstruction should be discussed with patients in case total resection of the ACL is to be performed, particularly in young active patients. Level of evidence: Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. 2023 BioMed Central Ltd unless otherwise stated. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. Instrumental treatment. Epub 2010 May 8. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Cookies policy. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. and transmitted securely. The pathogenesis remains controversial. https://www.physio-pedia.com/index.php?title=Anterior_Cruciate_Ligament_(ACL)_Mucoid_Degeneration&oldid=253974, Difficulty in climbing stairs, cross-leg sitting, squatting, Primary condition- Osteoarthritis, degenerative menisci, meniscal tear, Impingement of the soft tissue in the vicinity. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid 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 mean MINORS score was 9.5 out of 16 (412). Keywords: AJR Am J Roentgenol. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Radiology. W B Saunders Co. (2005) ISBN:0721602703. Mucoid change or mucoid degeneration refers to the irreversible tissue degeneration due to the accumulation of mucin within the fibers of tendons, ligaments, and fibrocartilage. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Glossary of terms for musculoskeletal radiology. Knee Surg Sports Traumatol Arthrosc 21(3):658663. Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was debrided. The patient presented with extension block of the knee. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. government site. 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. 287 (3): 912-921. -, Makino A, Pascual-Garrido C, Rolon A, Isola M, Muscolo DL. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 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. in 1999 [1]. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. 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). 2011. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. eCollection 2021. The https:// ensures that you are connecting to the This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. Risk factors Predisposing factors include the following 1: aging 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. Pan African Medical Journal. Clin Orthop Surg. Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. HHS Vulnerability Disclosure, Help Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. J Knee Surg. California Privacy Statement, Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Score: 4.7/5 (45 votes) . government site. Postoperative pain relief was reported in seven studies. 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. Skeletal Radiol. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. The ligament is mainly responsible for restraining anterior translation of knee. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. This study concerns complete ACL resec The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. J Orthop. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. Mucinous material within the substance of ACL produces pain and limited motion in the knee. 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. Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Methods: They respond well to a judicious arthroscopic release of the ACL with notchplasty. (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).
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