reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. 2. Glossary of terms for musculoskeletal radiology. Mucoid degeneration of both ACL and PCL - PubMed To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Chudasama et al. Privacy Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. 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. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. 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. Joshita Poojary - Sports Physical Therapist - Padmanabhan's - Linkedin 2011 Aug 1;19(8):1326-33. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). 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 . The mean follow up ranged from 13 to 72months. J Orthop. 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. Ayurvedic treatment for complete acl tear - Practo 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. Management of mucoid degeneration of the anterior cruciate ligament: a Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. 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. Federal government websites often end in .gov or .mil. Epub 2010 May 8. This was lowest in the study of Cha et al. 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. 2011. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. ACL Ganglion Cysts - Radsource 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. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. 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). [16]. At the time the article was last revised Dai Roberts had no recorded disclosures. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Mucoid degeneration of the patellar ligament in athletes. The origin of MDACL may be degenerative or traumatic. TS designed the project, literature search and wrote the manuscript. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. 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. Disclaimer. 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. Case report: Ventura et al. This site needs JavaScript to work properly. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. 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). What is Anterior Cruciate Ligament Mucoid Degeneration? . Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Mucoid degeneration of the anterior cruciate ligament Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. Second, methodological quality assessment showed that three studies had low methodological quality. Hide glossary Glossary. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Morice et al. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Epub 2011 Feb 18. Anterior knee pain is the more common complaint. Bookshelf 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. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. J Bone Joint Surg Ser B 81(2):304305. Unauthorized use of these marks is strictly prohibited. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. had the largest number of patients (91) with a mean age of 61 years, which was the oldest study population amongst the nine studies [16]. There was more than 20% loss to follow up in the study of Kim et al., while the three prospective studies had no loss to follow up [13, 14, 18]. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Orthopaedics & Traumatology: Surgery & Research. Therefore, indications for ACL resection must be carefully selected. Arthroscopy. Please enable it to take advantage of the complete set of features! Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. Tamer Sweed. Keywords: Initially, partial weightbearing is allowed. Bergin et al. Results: 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. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. official website and that any information you provide is encrypted (A) Bulging of, Fig. 2001;30(6):312315. Questions just answered: mucoid degeneration of acl physiotherapy. 4. Mucoid Degeneration Of Acl Treatment? The 140 Top Answers Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. [6], in 62% of patients (18 of 29) in the study of Lintz et al. Cite this article. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Besides, the patient may also have trouble in moving. and transmitted securely. Mucoid degeneration of the anterior cruciate ligament. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. Disclaimer. https://doi.org/10.1007/s00167-011-1433-0, Article It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. Cho SD, Youm YS, Lee CC et-al. Arthroscopic debridement may help relieve the anterior knee pain. 2010 Jun 1;96(4):400-6. Knee Surg Sports Traumatol Arthrosc. in 1999 [1]. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. to 44% in the study of Cha et al. Methods: The minimum follow-up was 3 years. The https:// ensures that you are connecting to the 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. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 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). Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. Khanna et al. Radiofrequency Ablation for Mucoid Degeneration of the Anterior Bone and joint imaging. and Ventura et al. 2011. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. 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. See this image and copyright information in PMC. 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). eCollection 2022 May-Jun. Clipboard, Search History, and several other advanced features are temporarily unavailable. Online ahead of print. An official website of the United States government. CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. National Library of Medicine (B) Partial resection, MeSH The ligament is mainly responsible for restraining anterior translation of knee. 2007;90(3):1923. 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. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . 2009. reported on the co-existence of mucoid degeneration and ganglia of the ACL. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. When refering to evidence in academic writing, you should always try to reference the primary (original) source. ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. The clinical presentation is one of posterior pain with limited flexion. Mucoid degeneration of the anterior cruciate ligament: Partial -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. 2008;24(6):642649. 2007;15 (1): 73-86. Keywords: It results in postoperative laxity, but rarely in frank instability. Four studies reported only postoperative scores, which were comparable to those in other studies. official website and that any information you provide is encrypted MAUDE Adverse Event Report: GENZYME BIOSURGERY (RIDGEFIELD) SYNVISC ONE Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. GG and AM interpreted the results and reviewed the manuscript. https://doi.org/10.1046/j.1445-2197.2003.02748.x, Ekhtiari S, Horner NS, Bedi A, Ayeni OR, Khan M. The learning curve for the Latarjet procedure: a systematic review. -, Makino A, Pascual-Garrido C, Rolon A, Isola M, Muscolo DL. CAS 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. Unable to process the form. Mucoid degeneration of both ACL and PCL. Conclusions: -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. (100%). Knee Surgery & Related Research Pan African Medical Journal. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. . Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. CIOS :: Clinics in Orthopedic Surgery The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and MethodsBetween December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis . A total of nine studies were eligible for review. statement and 2007;245 (3): 916-7. 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. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Epub 2008 Dec 17. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). . 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 . Twelve partial and 17 total resections were performed. This site needs JavaScript to work properly. The mean MINORS score was 9.5 out of 16 (412). Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. in 1999 [ 1 ]. Indian J Orthop 46(5):561565. government site. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. 2004;182 (5): 1283-7. Clinical significance of T2*-weighted gradient-echo MRI to monitor What is myxoid degeneration treatment? The success of treatment for MDACL and the subsequent risk of instability is not known. 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. Reeducation. Unable to load your collection due to an error, Unable to load your delegates due to an error. Rehabilitation, speech therapy, crenotherapy. https://doi.org/10.1016/j.arthro.2008.02.004, Morice A, Coupry A, Lintz F, Robert H (2013) Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Arthroscopy 24(6):642649. Arthroscopy 20(2):141146. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid W B Saunders Co. (2005) ISBN:0721602703. Clipboard, Search History, and several other advanced features are temporarily unavailable. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. 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]. Learn.Physio on LinkedIn: Quadriceps and hamstring weakness are common Cookies policy. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Epub 2010 May 8. Intact fibers are best seen on T2WI. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. 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. . Sagittal T2-weighted MRI view showing intact anterior, Fig. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Anterior cruciate ligament mucoid degeneration: Selecting the best The appearance can mimic acute or chronic interstitial partial tears of the ACL. 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the 1173185. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. No treatment is usually required. Pain was posterior in 23 knees (80%). Epub 2013 Aug 27. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. 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. Instrumental treatment. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. 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. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. What causes mucoid degeneration of ACL? Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. (2018) Radiology. 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. eCollection 2022 May-Jun. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Assessment of Anterior Cruciate Ligament (ACL) Degeneratio Mucosa Treatment What are the treatment options for anterior cruciate ligament mucoid mucoid degeneration of acl - Best Orthopedic doctor in Jaipur What you feel (symptoms) You feel heaviness in knee joint. Imaging: Plain radiographs Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. Postoperative pain relief was reported in seven studies. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. The aetiology of MDACL is not clearly understood. mucoid degeneration of acl mri. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Level of evidence: IV (retrospective cohort study). Instrumental treatment. 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. Postoperative clinical laxity was common, however, symptomatic instability was not. [Diagnosis and treatment of anterior cruciate ligament cysts]. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. 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. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. Epub 2021 Mar 8. Ligaments are very tough, fibrous tissue structures. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). 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. 1). 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. Radiology. Only nine studies met our inclusion criteria and they were all case series. reported the largest percentage of patients (27.5%) with a positive pivot test. FOIA 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. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. 2. in 1999 [1]. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . Int J Curr Res Aca Rev 4(11):1824 http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI (2008) Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 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. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. eCollection 2021. 8600 Rockville Pike Mucoid change | Radiology Reference Article | Radiopaedia.org Discussion: 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.