Categories were determined in accordance with the study of Ekhtiari et al. Orthop Traumatol Surg Res. sharing sensitive information, make sure youre on a federal Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Arthroscopy. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2 ). (A) Bulging of, Fig. International Journal of Orthopaedics. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Results: There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. Symptomatic ACL mucoid degeneration in middle-age athletes. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). in 1999 [ 1 ]. Mucoid degeneration of ACL Justamom21 Feb 17, 2023 7:27 AM Among other conditions - osteoarthritis, osteopenia, spondylolisthesis- an MRI report showed "severe mucoid degeneration of the ACL" in my left knee. AJR Am J Roentgenol. Four studies reported only postoperative scores, which were comparable to those in other studies. Bookshelf For non-comparative studies, this consists of eight questions. . Epub 2018 Jan 2. Fourteen knees (48%) had limited flexion, on average 97 degrees. Level of Evidence: Level IV. 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. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Postoperative clinical laxity was common, however, symptomatic instability was not. No treatment is usually required. GG and AM interpreted the results and reviewed the manuscript. The patient presented with extension block of the knee. 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. -, Fealy S, Kenter K, Dines JS, Warren RF. HHS Vulnerability Disclosure, Help The minimum follow-up was 3 years. official website and that any information you provide is encrypted ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . Two patients uderwent secondary ligamentoplasty. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. Federal government websites often end in .gov or .mil. There was strong association with chondral lesions and meniscal tears. Online ahead of print. This was lowest in the study of Cha et al. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. Knee Surg Sports Traumatol Arthrosc. Individuals with mucoid degeneration of the ACL were excluded. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Epub 2011 Feb 18. In the nine included studies, four different scores were used for outcome assessment. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). bling. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Epub 2010 May 8. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. 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]. volume33, Articlenumber:26 (2021) [Diagnosis and treatment of anterior cruciate ligament cysts]. 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. On clinical examination, the active range of motion showed a flexion deficit. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Knee Surg & Relat Res 33, 26 (2021). PMC 2. AJR Am J Roentgenol. TS designed the project, literature search and wrote the manuscript. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Average patient age was 49 (22 to 68) years. 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. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. Manage cookies/Do not sell my data we use in the preference centre. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. The .gov means its official. in 1999 [1]. Reeducation. See this image and copyright information in PMC. Part of 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]. CAS 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. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine Epub 2018 Aug 22. A 48-year-old-male patient presented with knee pain and limitation of motion. (61years), which was the largest study and represented more than one third of the total patients included in this review. In most cases Physiopedia articles are a secondary source and so should not be used as references. It has recently been postulated that mucoid degeneration of the ACL is related to the medial knee compartment joint space loss in patients with osteoarthritis or in the OA risk group 6. Rehabilitation, speech therapy, crenotherapy. Knee Surg Sports Traumatol Arthrosc. Results: After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. The https:// ensures that you are connecting to the https://doi.org/10.4103/0019-5413.128765, Article 2011. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Score: 4.7/5 (45 votes) . An official website of the United States government. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. 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. Noninfiltrating synovial cysts of the ACL were excluded. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. Careers. 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. Epub 2021 Mar 8. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. 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. What you feel (symptoms) You feel heaviness in knee joint. Indian J Orthop 48(2):197202. Conclusion: 2004;182 (5): 1283-7. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Arthroscopic debridement may help relieve the anterior knee pain. NCI CPTC Antibody Characterization Program. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Anterior knee pain is the more common complaint. Characteristic: "celery stalk" appearance. Unauthorized use of these marks is strictly prohibited. Chudasama CH, Chudasama VC, Prabhakar MM. 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. Epub 2008 Apr 18. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). 2013;15(1). Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. 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. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. All nine studies were case series; six were retrospective and three were prospective studies. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. None of the studies was a randomised controlled trial and none had a control group. Magn Reson Imaging Clin N Am. Mucoid degeneration of both ACL and PCL. The site is secure. Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. MM and A performed the literature search, and data analysis. -, McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. 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. Accessibility Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. 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. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Introduction: Accessibility 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). Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Epub 2011 Feb 18. CAS Therefore, indications for ACL resection must be carefully selected. https://doi.org/10.1302/0301-620X.81B2.0810304, Article Orthopaedics & Traumatology: Surgery & Research. Reeducation. Its signal is increased on all sequences. Physiotherapy. Bergin et al. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. Arthroscopy. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Symptoms included limited range of motion (ROM) and posterior knee pain. 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. Disclaimer. Would you like email updates of new search results? and transmitted securely. See this image and copyright information in PMC. What causes mucoid degeneration of ACL? Arthroscopy 24(6):642649. Anatomopathology samples were collected in 18 cases. These appearances must be differentiated from mucoid degeneration of the intact ACL. 1992;159(2):35760. Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. Terms and Conditions, The appearance can mimic acute or chronic interstitial partial tears of the ACL. 2008;24(6):642649. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Mucoid degeneration itself is described as a yellow or brown substance which can be either seen through the most anterior fibers of the ACL or found by probing between them [ 19, 35] (Fig. The total number of patients with symptomatic instability was 18 out of 288 (6%). 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. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. This systematic review has some limitations. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 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. Anterior cruciate ligament mucoid degeneration. 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. ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration.