The site is secure. Methods: The minimum follow-up was 3 years. Epub 2008 Dec 17. This bicentric, retrospective cohort study with an average follow-up of 6years involved 27 patients (29 knees) presenting with symptomatic ACL mucoid degeneration validated by magnetic resonance imaging (MRI). J Clin Epidemiol 62(10):10061012. Careers. to 44% in the study of Cha et al. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Arthroscopy. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. AJR Am J Roentgenol. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. FOIA "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. 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.). 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). At the time the article was created Frank Gaillard had no recorded disclosures. 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. 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. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. 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]. The extracted data were assessed for meta-analysis. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2009. Ligaments are very tough, fibrous tissue structures. 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. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. . 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. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 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. It may lead to knee pain. The appearance can mimic acute or chronic interstitial partial tears of the ACL. PMC National Library of Medicine Epub 2010 May 8. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. https://doi.org/10.1007/s00167-011-1433-0, Article AJR Am J Roentgenol. Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. This may support the theory that it is a degenerative process. Later studies reported that changes consist of mucoid Results degeneration, neovascularisation, and tendon sheath hyper- Nineteen patients met the inclusion criteria and were inclu- trophy. 2011 Jun;25(6):650-2. 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. 3. This site needs JavaScript to work properly. PubMed Central PMC eCollection 2022 May-Jun. Method. 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. All rights reserved. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. Patient having mucoid degeneration of ACL seeks multiple orthopedic consultation and most of the time treating orthopedican miss its diagnosis either because of lack of experience or rare cause of pain unless doctor sought magnetic resonance imaging (MRI) of knee. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. Each study was scored 02 on each question, with a global ideal score of 16. Keywords: 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. Results: Reeducation. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. MeSH At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine 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. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. Manage cookies/Do not sell my data we use in the preference centre. 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. Federal government websites often end in .gov or .mil. Methods: Please enable it to take advantage of the complete set of features! A long duration of non-specific knee pain in a patient should be evaluated with MRI. Conditions that resembles the clinical findings are: Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. By using this website, you agree to our However, the authors did not report whether there were any other patients with symptomatic instability. It results in postoperative laxity, but rarely in frank instability. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. Arthroscopy 24(6):642649. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. 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. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. PROSPERO. Symptomatic instability was highest in the study of Lintz et al. Arthroscopy. The https:// ensures that you are connecting to the Conclusions: https://doi.org/10.2214/ajr.182.5.1821283, Article Cite this article. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. [17] do not mention whether any patients underwent biopsy (Table 3). Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. MRI - Interstitial ACL tear With Mild knee joint effusion ,No evidence of discontinuation of fibre Can Interstitial ACL tear heal without surgery Asked for Male, 22 Years 78 Views v Dr. Abhishek Kaushik Joint Replacement Surgeon | Delhi 1/1 people found this helpful Hi. J Sports Med Phys Fitness 48(4):483487, PubMed Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. For non-comparative studies, this consists of eight questions. J Arthrosc Joint Surg 3(1):2833. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. 2004;182 (5): 1283-7. Noninfiltrating synovial cysts of the ACL were excluded. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Learn how we can help 704 views Reviewed >2 years ago Thank Two patients uderwent secondary ligamentoplasty. CAS Epub 2013 Aug 27. 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. Fig. Mucoid degeneration of the anterior cruciate ligament: a case report. This is a rare pathological condition, in which, there is increased signal from within the ligament. The minimum follow-up was 3 years. Mucoid degeneration of ACL. in 1999 [1]. Skeletal Radiology. and transmitted securely. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. An official website of the United States government. 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. Knee Surg Sports Traumatol Arthrosc. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. PubMedGoogle Scholar. Seventeen females (67%) and eight males (33%) were included in the final analysis. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. 2004;182(5):12837. The mean follow up ranged from 13 to 72months. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Postoperative recovery was four weeks on average. Postoperative symptomatic instability was not common in eight studies, but was observed in 48% of patients in the study of Lintz et al., with two patients having a delayed ACL reconstruction. Morice et al. official website and that any information you provide is encrypted The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. 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. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. Accessibility The extracted data were heterogeneous in terms of outcome assessment. Rajani AM, Shah UA, Mittal ARS, Gupta S, Garg R, Punamiya M. Knee Surg Relat Res. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Clipboard, Search History, and several other advanced features are temporarily unavailable. Score: 4.7/5 (45 votes) . It results in postoperative laxity, but rarely in frank instability. Pandey, Vivek et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. In six of the nine studies [6, 14, 16,17,18], arthroscopic debridement of the ACL was associated with simultaneous partial meniscectomy; this ranged from 13% in the study of Morice et al. Besides, the patient may also have trouble in moving. Introduction: On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Instrumental treatment. 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). The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Physiotherapy. However, MDACL is asymptomatic in most patients. Conclusion: . (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). 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Knee Surg Sports Traumatol Arthrosc 19(8):13261333. HHS Vulnerability Disclosure, Help It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. 1173185. eCollection 2013. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. National Library of Medicine http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782. (A) Bulging of, Fig. 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. 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. The mean MINORS score was 9.5 (range 412). FOIA All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res.