Careers. Background: ACL tears don't heal as such. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. what causes mucoid degeneration of acl. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Unable to load your collection due to an error, Unable to load your delegates due to an error. Arthroscopy. The mean age of patients ranged from 31 to 78years. 1. 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. Bookshelf ANZ J Surg 73(9):712716. The ligament is mainly responsible for restraining anterior translation of knee. Mucoid degeneration of ACL is a disease affecting ACL in which mucoid like substance (glycosaminoglycans) gets interspersed within the substance of ACL and as a result ACL gets thickened. Read More Created for people with ongoing healthcare needs but benefits everyone. This appearance can mimic acute or chronic interstitial partial tears of the ligament. 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. Federal government websites often end in .gov or .mil. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. Arthroscopic debridement of the ACL results in satisfactory pain relief and improvement in knee outcome scores. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. Two patients uderwent secondary ligamentoplasty. In most cases Physiopedia articles are a secondary source and so should not be used as references. 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). Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. PMC Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). J Clin Epidemiol 62(10):10061012. National Library of Medicine 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 retrospective study by Kim et al. The site is secure. All nine studies were case series; six were retrospective and three were prospective studies. 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. official website and that any information you provide is encrypted Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 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. Bethesda, MD 20894, Web Policies Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Would you like email updates of new search results? mucoid degeneration acl symptoms. 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. https://www.physio-pedia.com/index.php?title=Anterior_Cruciate_Ligament_(ACL)_Mucoid_Degeneration&oldid=253974, Difficulty in climbing stairs, cross-leg sitting, squatting, Primary condition- Osteoarthritis, degenerative menisci, meniscal tear, Impingement of the soft tissue in the vicinity. Imaging: Plain radiographs Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Arthroscopic diagnostic criteria [7] are (1) continuous ACL fibres, (2) increased ACL volume, (3) yellowish-coloured material expressed on palpation and (4) loss of ACL synovial lining. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). . The origin of MDACL may be degenerative or traumatic. 2008 Jun;24(6):642-9. doi: 10.1016/j.arthro.2008.02.004. Keywords: We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. The site is secure. The patient presented with extension block of the knee. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. Clipboard, Search History, and several other advanced features are temporarily unavailable. This makes it difficult to relate the improvement of symptoms to ACL debridement. Sep 2017 - Feb 20186 months. J Bone Joint Surg Br. 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. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. and transmitted securely. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Its signal is increased on all sequences. [6], in 62% of patients (18 of 29) in the study of Lintz et al. 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? HHS Vulnerability Disclosure, Help Bethesda, MD 20894, Web Policies International Journal of Orthopaedics. In the nine included studies, four different scores were used for outcome assessment. See this image and copyright information in PMC. The mean follow up ranged from 13 to 72months. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). 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. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. The knee is a complex synovial joint that can be affected by a range of pathologies: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. 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. 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). J Arthrosc Joint Surg 3(1):2833. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. 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.). Anterior knee pain is the more common complaint. 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. https://doi.org/10.1016/j.jclinepi.2009.06.005. 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 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. (B) Partial resection, MeSH Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Patients will . 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. Preoperative and postoperative results of eleven patient were compared. 2011;19(3):408411. The aetiology of MDACL is not clearly understood. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Tamer Sweed. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Ventura et al. A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. Online ahead of print. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. Introduction: By using this website, you agree to our -. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. Arthroscopic findings. . All rights reserved. Ligaments hold our bones together and allow us to bend, twist, pivot and rapidly accelerate and decelerate and yet maintain the stability of our joints. Average patient age was 49 (22 to 68) years. Generally, we know little about this condition. Before NCI CPTC Antibody Characterization Program. Questions just answered: mucoid degeneration of acl physiotherapy. Physical Therapy. Arthroscopy 24(6):642649. The extracted data were heterogeneous in terms of outcome assessment. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. 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. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. AJR Am J Roentgenol. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. J Chin Med Assoc. CAS Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. These appearances must be differentiated from mucoid degeneration of the intact ACL. https://doi.org/10.4103/0019-5413.128765, Article Copyright 2010 Elsevier Masson SAS. Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Springer Nature. 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. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Instrumental treatment. Mucoid degeneration of both ACL and PCL. 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. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Chudasama et al. Knee Surg Sports Traumatol Arthrosc. Arthroscopy. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Score: 4.7/5 (45 votes) . The https:// ensures that you are connecting to the Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. 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). The .gov means its official. mucoid degeneration of acl mri. Knee. 2020 Jun 2. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: a case report. -, Hodler J, Haghighi P, Trudell D, Resnick D. The cruciate ligaments of the knee: Correlation between MR appearance and gross and histologic findings in cadaveric specimens. This is a rare pathological condition, in which, there is increased signal from within the ligament. HHS Vulnerability Disclosure, Help government site. Roberts CC, Towers JD, Spangehl MJ et-al. Presentation Patients usually present with nonspecific posterior knee pain with restriction of flexion. sharing sensitive information, make sure youre on a federal Initially, partial weightbearing is allowed. 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. However, symptomatic instability was not common. Sweed, T., Mussa, M., El-Bakoury, A. et al. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Disclaimer. (A) Bulging of, Fig. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. official website and that any information you provide is encrypted 2018;4(4):875-80. 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). Please enable it to take advantage of the complete set of features! Check for errors and try again. The site is secure. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Accessibility Accessibility Hide glossary Glossary. Arthroscopy. PubMed 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). CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. Physiotherapy. Discussion: The appearance can mimic acute or chronic interstitial partial tears of the ACL. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Bergin D, Morrison WB, Carrino JA et-al. 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. The mean MINORS score was 9.5 out of 16 (412). 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). government site. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. reported the largest percentage of patients (27.5%) with a positive pivot test. (10%) and highest in the study of Ventura et al. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. 8600 Rockville Pike Truncation means that the . 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. FOIA PMC 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Arch Orthop Trauma Surg. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. 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). Characteristic: "celery stalk" appearance. Clin Orthop Surg 10(3):307314. Bethesda, MD 20894, Web Policies Epub 2008 Dec 17. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. 1 Its prevalence in magnetic resonance imaging (MRI) is 1.8-5.3%, but not all lesions are symptomatic.2, 3 It is characterized by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Mucinous material within the substance of ACL produces pain and limited motion in the knee. Noninfiltrating synovial cysts of the ACL were excluded. Bookshelf Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. It is a chronic degenerative change of a bulky ACL that may lead to notch . An official website of the United States government. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. 2011 Aug 1;19(8):1326-33. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. The mean MINORS score was 9.5 (range 412). Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Rehabilitation, orthophony, crenotherapy. 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. 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. Knee Surg Sports Traumatol Arthrosc. Resnick D, Kransdorf MJ. This study concerns complete ACL resec What Is Mucoid Degeneration of the ACL? All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. Knee Surg Sports Traumatol Arthrosc 21(3):658663. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. . Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. Before statement and Skeletal Radiol. At the time the article was created Frank Gaillard had no recorded disclosures. All nine studies assessed the outcome of arthroscopic debridement of MDACL. 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. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Unauthorized use of these marks is strictly prohibited. The clinical presentation is one of posterior pain with limited flexion. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. Arthroscopy 20(2):141146. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. IV (retrospective cohort study). 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. Furthermore, this raises the question as to whether the symptoms (pain and diminished range of movement) were solely due to MDACL and not secondary to other associated pathological conditions. 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. 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 https:// ensures that you are connecting to the 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. 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. Answer (1 of 2): Most of the time mucoid degenrative changes in the ACL does not cause any problemonly if u have sign of ACL instability or the bending of the knee is reduced you may need a arthroscopic evaluation usually u may skip without ACL reconstruction but some of us will need AcL recons. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Epub 2010 May 8. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. Besides, the patient may also have trouble in moving. Postoperative recovery was four weeks on average. and transmitted securely. 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 ]. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. 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]. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. The site is secure. Disclaimer. 2001;30(6):312315. PMC Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.