Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. Arch Orthop Trauma Surg. AJR Am J Roentgenol. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. Accessibility Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Read More Created for people with ongoing healthcare needs but benefits everyone. California Privacy Statement, The origin of MDACL may be degenerative or traumatic. Arthroscopy. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. Any discrepancy was resolved by the senior author. 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. 4. Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.817.97 years (42-74 years). This ranged from 90 to 95% in all studies, except in the report by Kim et al., where only 53.8% of patients (57/106) had complete pain relief after surgery. At the time the article was last revised Dai Roberts had no recorded disclosures. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. : A Meta-Analysis. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. (2018) Radiology. FOIA Questions just answered: mucoid degeneration of acl physiotherapy. The .gov means its official. 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. Generally, we know little about this condition. PMC Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). Unauthorized use of these marks is strictly prohibited. Sep 2017 - Feb 20186 months. Federal government websites often end in .gov or .mil. Keywords: Bergin et al. Pan African Medical Journal. Clin Orthop Surg 10(3):307314. Mucinous material within the substance of ACL produces pain and limited motion in the knee. to 44% in the study of Cha et al. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. . 2009. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. 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). 2018. http://journals.sagepub.com/doi/10.1177/2325967118786930, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. Orthop Traumatol Surg Res. See this image and copyright information in PMC. This site needs JavaScript to work properly. 2011 Jun;25(6):650-2. Khanna et al. All rights reserved. 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 Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Knee Surg Sports Traumatol Arthrosc. The minimum follow-up was 3 years. Conclusion: Anatomopathology samples were collected in 18 cases. 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). [17] do not mention whether any patients underwent biopsy (Table 3). Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. HHS Vulnerability Disclosure, Help Would you like email updates of new search results? Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 1. Fig. A total of nine studies were eligible for review. Roberts CC, Towers JD, Spangehl MJ et-al. What causes mucoid degeneration of ACL? government site. -. Anterior cruciate ligament mucoid degeneration. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Ventura et al. Level of Evidence: Level IV. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Its signal is increased on all sequences. . 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Before 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population-A 2-Year Follow-up Study. Knee. J Chin Med Assoc. Average patient age was 49 (22 to 68) years. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. The mean age of patients ranged from 31 to 78years. The site is secure. This systematic review has some limitations. Eight studies showed postoperative improvement in range of motion, whereas Khanna et al. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. Indian J Orthop 48(2):197202. 2011 Aug 1;19(8):1326-33. Arthroscopy. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Only nine studies met our inclusion criteria and they were all case series. Physical Therapy. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. Truncation means that the . and transmitted securely. sharing sensitive information, make sure youre on a federal 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. Bethesda, MD 20894, Web Policies Part of 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 . Arthroscopy. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. NCI CPTC Antibody Characterization Program. 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). AJR Am J Roentgenol. Mucoid degeneration of the anterior cruciate ligament. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Epub 2011 Feb 18. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. 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. Besides, the patient may also have trouble in moving. The extracted data were heterogeneous in terms of outcome assessment. 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. (B) Partial resection, MeSH The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. 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. The mean MINORS score was 9.5 out of 16 (412). Federal government websites often end in .gov or .mil. Knee Surg Sports Traumatol Arthrosc. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Meniscectomy was undertaken in 11 cases (41%). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. bling. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. 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. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). https://doi.org/10.1302/0301-620X.81B2.0810304, Article Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Knee Surg Sports Traumatol Arthrosc. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. What is myxoid degeneration treatment? Mucoid degeneration of the anterior cruciate ligament. government site. Keywords: Morice et al. Provided by the Springer Nature SharedIt content-sharing initiative. 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. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Clipboard, Search History, and several other advanced features are temporarily unavailable. Bergin et al. PubMed eCollection 2022 May-Jun. J Bone Joint Surg Br. Eight studies reported postoperative instability. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. All patients (100%, n=11) reported an improvement in pain. [Diagnosis and treatment of anterior cruciate ligament cysts]. mucoid degeneration of acl mri. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Careers. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a well-recognized pathology characterized by the degradation of collagen fibers and infiltration of a mucoidlike substance, [1,2 . This site needs JavaScript to work properly. Level of evidence: 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. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Epub 2011 Feb 18. what causes mucoid degeneration of acl. Reeducation. Unable to load your collection due to an error, Unable to load your delegates due to an error. reported on the co-existence of mucoid degeneration and ganglia of the ACL. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. 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. It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. 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. Before In the nine included studies, four different scores were used for outcome assessment. In the Lintz study, total resection of the ACL was performed in 17 out of 29 knees, while in the Ventura study total resection was performed in 17 out of 25 patients. PMC 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. report that one patient had ACL reconstruction simultaneously after the ACL debridement. In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). Pandey, Vivek et al. What Is Mucoid Degeneration of the ACL? Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. official website and that any information you provide is encrypted Risk factors Predisposing factors include the following 1: aging Rehabilitation, orthophony, crenotherapy. However, symptomatic instability was not common. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. FOIA Orthopaedics & Traumatology: Surgery & Research. Pain was posterior in 23 knees (80%). Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. IV (retrospective cohort study). Accessibility The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). PubMed Central PubMed J Clin Epidemiol 62(10):10061012. 2011. For non-comparative studies, this consists of eight questions. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Epub 2010 May 8. 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. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. That is usually the journal article where the information was first stated. ACL tears don't heal as such. Would you like email updates of new search results? HHS Vulnerability Disclosure, Help They respond well to a judicious arthroscopic release of the ACL with notchplasty. 1992;159(2):35760. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. National Library of Medicine PubMedGoogle Scholar. Accessibility Physical therapy typically begins 7-10 days after the procedure. After the literature search and exclusion of duplicates, 54 papers were retrieved: 12 articles were assessed for eligibility, and of these, 9 papers met the inclusion criteria and were included in the systematic review [3, 6, 13,14,15,16,17,18,19] (Fig. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. Resnick D, Kransdorf MJ. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Bookshelf Hypothesis: Ligaments are very tough, fibrous tissue structures. statement and Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Epub 2018 Aug 22. [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. Hide glossary Glossary. 8600 Rockville Pike The patient presented with extension block of the knee. 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. Epub 2013 Aug 27. However, in most studies a proportion of patients simultaneously underwent other arthroscopic procedures for associated pathological knee conditions (44% meniscectomies in the study of Cha et al.). 1. The retrospective study by Kim et al. sharing sensitive information, make sure youre on a federal The clinical presentation is one of posterior pain with limited flexion. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. government site. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Other theories include Degenerative theory- MD could occur due to ageing.[3]. Knee Surg Sports Traumatol Arthrosc. Patients and methods: eCollection 2021. The origin of MDACL may be degenerative or traumatic. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. 5. Copyright 2010 Elsevier Masson SAS. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. 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 . Before This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. A total of 313 knees in 292 patients were included. Reeducation. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . It may lead to knee pain. Arthroscopic debridement may help relieve the anterior knee pain. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . Disclaimer. Epub 2008 Apr 18. Cookies policy. Before Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. and transmitted securely. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. 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). Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. volume33, Articlenumber:26 (2021) (61years), which was the largest study and represented more than one third of the total patients included in this review. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Preoperative and postoperative results of eleven patient were compared. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. The extracted data were assessed for meta-analysis. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. 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).