official website and that any information you provide is encrypted Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. CAS CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. government site. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. What causes mucoid degeneration of ACL? Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. (Table 3). Postoperative pain relief was reported in seven studies. Part of -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. [16]. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Rehabilitation, speech therapy, crenotherapy. Orthop Traumatol Surg Res. 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). A long duration of non-specific knee pain in a patient should be evaluated with MRI. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. J Sports Med Phys Fitness 48(4):483487, PubMed The https:// ensures that you are connecting to the Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Knee Surg Sports Traumatol Arthrosc. government site. 1. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. https://doi.org/10.1302/0301-620X.81B2.0810304, Article A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Hotchen AJ, Demetriou C, Edwards D, Melton JTK. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. 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). (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). Knee Surg Sports Traumatol Arthrosc. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of 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. The total number of patients with symptomatic instability was 18 out of 288 (6%). Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. J Bone Joint Surg Ser B 81(2):304305. Pandey, Vivek et al. 1). It can cause pain and to a meniscal tear. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. . Clinical outcome was reported using a variety of scores (the Lysholm and International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the visual analogue scale (VAS) score) in the different studies; these are summarized in Table 4. This site needs JavaScript to work properly. Arthroscopic findings. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. J Chin Med Assoc. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. 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. 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. Arch Orthop Trauma Surg. 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. (A) Bulging of the hypertrophied anterior cruciate ligament. 2011. 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. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. Mucoid degeneration of the anterior cruciate ligament. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. Mucoid degeneration of the anterior cruciate ligament: a case report. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. Please enable it to take advantage of the complete set of features! However, MDACL is asymptomatic in most patients. This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. reported the largest percentage of patients (27.5%) with a positive pivot test. Unauthorized use of these marks is strictly prohibited. 4. (61years), which was the largest study and represented more than one third of the total patients included in this review. Before -, Fealy S, Kenter K, Dines JS, Warren RF. 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. Knee Surgery, Sports Traumatology, Arthroscopy. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Mucoid degeneration of the anterior cruciate ligament. (A) Bulging of, Fig. Unable to load your collection due to an error, Unable to load your delegates due to an error. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. 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. GG and AM interpreted the results and reviewed the manuscript. and transmitted securely. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. 287 (3): 912-921. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. Individuals with mucoid degeneration of the ACL were excluded. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Accessibility : A Meta-Analysis. Radiology. Skeletal Radiology. in 1999 [1]. Bethesda, MD 20894, Web Policies Rajani AM, Shah UA, Mittal ARS, Gupta S, Garg R, Punamiya M. Knee Surg Relat Res. 2. Symptomatic ACL mucoid degeneration in middle-age athletes. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. 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. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. and Ventura et al. Arthroscopy. Chudasama et al. The rate of simultaneous meniscectomy ranged from 13 to 44%. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Please enable it to take advantage of the complete set of features! Knee Surg Sports Traumatol Arthrosc. 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. Therefore, indications for ACL resection must be carefully selected. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. 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. Despite the low rate of complications in all studies, there was a high incidence of postoperative knee laxity, demonstrated by a positive Lachman test, in most studies. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). This systematic review has some limitations. 2007;15 (1): 73-86. The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. 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. PROSPERO. 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. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. The https:// ensures that you are connecting to the 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Fourteen knees (48%) had limited flexion, on average 97 degrees. Arthroscopic findings. Level of Evidence: Level IV. 1999;81(2):304305. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 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). AJR Am J Roentgenol. IV (retrospective cohort study). MM and A performed the literature search, and data analysis. report that one patient had ACL reconstruction simultaneously after the ACL debridement. Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. Along with that, it also controls the internal rotation. 2011;19(3):408411. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Manage cookies/Do not sell my data we use in the preference centre. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. No treatment is usually required. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. sharing sensitive information, make sure youre on a federal 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. This study concerns complete ACL resec Chudasama CH, Chudasama VC, Prabhakar MM. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. 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. 2004;182(5):12837. 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). However, the authors did not report whether there were any other patients with symptomatic instability. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. -. Only nine studies met our inclusion criteria and they were all case series. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Federal government websites often end in .gov or .mil. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. Introduction: A 48-year-old-male patient presented with knee pain and limitation of motion. All nine studies were case series; six were retrospective and three were prospective studies. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. government site. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Mucoid degeneration of ACL. statement and Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. National Library of Medicine Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. 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 . [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%). Case report: The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. Knee Surg Sports Traumatol Arthrosc. to 44% in the study of Cha et al. TS designed the project, literature search and wrote the manuscript. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. The author(s) read and approved the final manuscript. Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores.
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