2022.08.24 WednesdaySymptomatic instability was highest in the study of Lintz et al. 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. 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. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 BioMed Central Ltd unless otherwise stated. Level of Evidence: Level IV. reported on the co-existence of mucoid degeneration and ganglia of the ACL. The appearance can mimic acute or chronic interstitial partial tears of the ACL. https://doi.org/10.4103/0019-5413.128765, Article This was lowest in the study of Cha et al. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. 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. In most cases Physiopedia articles are a secondary source and so should not be used as references. J Sports Med Phys Fitness 48(4):483487, PubMed Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-3615, Case 11: with Hoffa fat pad ganglion cyst, Case 12: tibial nerve schwannoma and ACL mucoid degeneration, Case 1: Complete ACL tear and meniscal tears, Case 2: Anomalous insertion of the medial meniscus, View Frank Gaillard's current disclosures, see full revision history and disclosures, anterior cruciate ligament ganglion cysts, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Mucoid degeneration of the anterior cruciate ligament, congenital or acquired synovial tissue entrapment between ACL fibers. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. HHS Vulnerability Disclosure, Help -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. Cho SD, Youm YS, Lee CC et-al. Eight studies reported postoperative instability. and transmitted securely. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. 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. government site. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. 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. Morice et al. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. 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. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. Pandey, Vivek et al. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. sharing sensitive information, make sure youre on a federal 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. Epub 2010 May 8. Four studies reported only postoperative scores, which were comparable to those in other studies. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mucoid degeneration of ACL. 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. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Arthroscopy. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. eCollection 2021. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. The https:// ensures that you are connecting to the It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. 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. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. The authors declare that they have no competing interests. Would you like email updates of new search results? (61years), which was the largest study and represented more than one third of the total patients included in this review. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. 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). Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Hypothesis: HHS Vulnerability Disclosure, Help [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. 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. 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. Accessed 1 Mar 2021. Epub 2018 Apr 21. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. An official website of the United States government. 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. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. All patients (100%, n=11) reported a good to very good surgery satisfaction. Instrumental treatment. 2011 Jun;25(6):650-2. Arch Orthop Trauma Surg. 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). Arthroscopic findings. The .gov means its official. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). FOIA Epub 2013 Aug 27. Orthop Traumatol Surg Res 96(4):400406, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. 2011. Conclusions: -, Fealy S, Kenter K, Dines JS, Warren RF. . 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. 1). eCollection 2013. Introduction: what causes mucoid degeneration of acl. 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 . Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Ventura et al. 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. This site needs JavaScript to work properly. Therefore, indications for ACL resection must be carefully selected. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Results: Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Arch Orthop Trauma Surg. PubMed 4. Conclusion: Treatment of ACL mucoid degeneration by this modality is effective in preventing recurrence, post-operative laxity and provides better functional outcome compared to the classical partial resection of the degenerated ACL. mucoid degeneration acl symptoms. All patients (100%, n=11) reported an improvement in pain. Disclaimer. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). Noninfiltrating synovial cysts of the ACL were excluded. 2008;24(6):642649. Patients and methods: Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. 3. and transmitted securely. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. GG and AM interpreted the results and reviewed the manuscript. Provided by the Springer Nature SharedIt content-sharing initiative. Eight studies showed postoperative improvement in range of motion, whereas Khanna et al. It results in postoperative laxity, but rarely in frank instability. International Journal of Orthopaedics. They respond well to a judicious arthroscopic release of the ACL with notchplasty. J Bone Joint Surg Br. Terms and Conditions, Symptomatic ACL mucoid degeneration in middle-age athletes. This may support the theory that it is a degenerative process. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. 2. 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. Individuals with mucoid degeneration of the ACL were excluded. Careers. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. 2011;19(3):408411. Knee Surgery & Related Research Arthroscopy. 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. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 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. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. 2 ). Clipboard, Search History, and several other advanced features are temporarily unavailable. Indian J Orthop 48(2):197202. The clinical presentation is one of posterior pain with limited flexion. Imaging: Plain radiographs 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. Careers. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 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. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. The appearance can mimic acute or chronic interstitial partial tears of the ACL. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01).
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