Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? 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]. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Case report: 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). 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Postoperative clinical laxity was common, however, symptomatic instability was not. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Skelet Radiol 30(6):312315. The https:// ensures that you are connecting to the 2013;15(1). The .gov means its official. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Along with that, it also controls the internal rotation. Its signal is increased on all sequences. Accessibility The mean MINORS score was 9.5 out of 16 (412). Mucoid degeneration of the anterior cruciate ligament. what causes mucoid degeneration of acl. On clinical examination, the active range of motion showed a flexion deficit. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. All nine studies included patients with symptomatic MDACL confirmed by MRI (Table3). A 48-year-old-male patient presented with knee pain and limitation of motion. 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). 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. 2011 Jun;25(6):650-2. 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. Preoperative magnetic resonance imaging (MRI), Fig. HHS Vulnerability Disclosure, Help 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. Pan African Medical Journal. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. [6], in 62% of patients (18 of 29) in the study of Lintz et al. Accessibility . Symptomatic instability was highest in the study of Lintz et al. The presence of intraligamentous mucoid degeneration in the ACL is demonstrated as a source of knee pain without instability and partial ACL debridement did not preclude adequate knee stability. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). National Library of Medicine Knee Surg Sports Traumatol Arthrosc. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Knee Surgery & Related Research Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. 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. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. The anterior cruciate ligament (ACL) is an important ligament in the knee. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. 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. Symptomatic ACL mucoid degeneration in middle-age athletes. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. An official website of the United States government. (61years), which was the largest study and represented more than one third of the total patients included in this review. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. Arthroscopy. Learn how we can help 704 views Reviewed >2 years ago Thank Before Management of mucoid degeneration of the anterior cruciate ligament: a systematic review, https://doi.org/10.1186/s43019-021-00110-6, https://doi.org/10.1302/0301-620X.81B2.0810304, https://doi.org/10.1007/s00167-011-1433-0, https://doi.org/10.2214/ajr.182.5.1821283, https://doi.org/10.1007/s00167-012-1991-9, https://doi.org/10.1016/j.arthro.2003.11.030, https://doi.org/10.1016/j.jclinepi.2009.06.005, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782, https://doi.org/10.1046/j.1445-2197.2003.02748.x, http://journals.sagepub.com/doi/10.1177/2325967118786930, http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, https://doi.org/10.1016/j.arthro.2008.02.004, https://doi.org/10.1016/j.jajs.2015.12.001, https://doi.org/10.4055/cios.2018.10.3.307, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. (Table 3). 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. 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). The appearance can mimic acute or chronic interstitial partial tears of the ACL. Initially, partial weightbearing is allowed. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. This site needs JavaScript to work properly. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Mucoid degeneration of ACL. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. Bookshelf Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. Knee Surg Sports Traumatol Arthrosc. 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. National Library of Medicine Imaging: Plain radiographs Three reviewers (an experienced librarian and two of the authors) independently searched these databases. 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. Would you like email updates of new search results? 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. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. Papadopoulou P. The celery stalk sign. This makes it difficult to relate the improvement of symptoms to ACL debridement. in 1999 [ 1 ]. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. 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. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. 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 can cause pain and to a meniscal tear. Fourteen knees (48%) had limited flexion, on average 97 degrees. -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. The extracted data were heterogeneous in terms of outcome assessment. The success of treatment for MDACL and the subsequent risk of instability is not known. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. The patient presented with extension block of the knee. Reeducation. 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. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. J Chin Med Assoc. Bookshelf 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. 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). 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. https://doi.org/10.4103/0019-5413.128765, Article 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. 2006;69(9):44952. A long duration of non-specific knee pain in a patient should be evaluated with MRI. 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). Arthroscopic findings. 8600 Rockville Pike Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. (A) Bulging of, Fig. 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. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. The retrospective study by Kim et al. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. Method. Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. All patients (100%, n=11) reported an improvement in pain. The rate of simultaneous meniscectomy ranged from 13 to 44%. Roberts CC, Towers JD, Spangehl MJ et-al. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 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. Epub 2018 Aug 22. https://doi.org/10.1302/0301-620X.81B2.0810304, Article Arch Orthop Trauma Surg. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. Second, methodological quality assessment showed that three studies had low methodological quality. FOIA 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. Arch Orthop Trauma Surg. It is a chronic degenerative change of a bulky ACL that may lead to notch impingement syndrome in the absence of instability symptoms and significant trauma history [ 1, 2, 3, 4 ]. Keywords: Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. J Orthop. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Clin Orthop Surg 10(3):307314. 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. statement and {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Epub 2011 Feb 18. Clipboard, Search History, and several other advanced features are temporarily unavailable. Mucoid degeneration of both ACL and PCL. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. 2011;19(3):408411. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. and transmitted securely. Arthroscopic findings. 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 Pain was posterior in 23 knees (80%). and transmitted securely. Epub 2021 Mar 8. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. to 44% in the study of Cha et al.
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