The author(s) read and approved the final manuscript. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. 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]. 2008;24(6):642649. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Epub 2013 Aug 27. report that one patient had ACL reconstruction simultaneously after the ACL debridement. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Hotchen AJ, Demetriou C, Edwards D, Melton JTK. 3. Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. Symptomatic ACL mucoid degeneration in middle-age athletes. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. 2001;30(6):312315. 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. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. bling. Loreto v. Kijakazi, 1:22-CV-1404-JDG | Casetext Search + Citator This makes it difficult to relate the improvement of symptoms to ACL debridement. The total number of patients with symptomatic instability was 18 out of 288 (6%). 8600 Rockville Pike J Orthop. 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. PMC 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. Federal government websites often end in .gov or .mil. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. (100%). 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. Arthroscopy. W B Saunders Co. (2005) ISBN:0721602703. Magn Reson Imaging Clin N Am. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. 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. and Ventura et al. Chudasama et al. Keywords: 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. Epub 2018 Jan 2. https://doi.org/10.1016/j.jajs.2015.12.001, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J (2018) Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. 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. Epub 2010 May 8. Accessed 1 Mar 2021. 2 ). Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. 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 causes mucoid degeneration of ACL? MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. The .gov means its official. Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Arthroscopy. 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/. government site. The .gov means its official. 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. Unauthorized use of these marks is strictly prohibited. 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). Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Ventura et al. All patients (100%, n=11) reported an improvement in pain. Orthopedics; anterior cruciate ligament; arthoscopy. 1). 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. Papadopoulou P. The celery stalk sign. 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. 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 anterior cruciate ligament (ACL). Anterior cruciate ligament mucoid degeneration - Radiopaedia No treatment is usually required. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Bergin et al. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Mucoid cystic degeneration of the cruciate ligament. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Disclaimer. Along with that, it also controls the internal rotation. PubMedGoogle Scholar. Open Grey database was searched for grey literature using the same keywords. (Table 3). Other theories include Degenerative theory- MD could occur due to ageing.[3]. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Cite this article. ACL Mucoid Degeneration in Knee - Diagnosis & Treatment | Dr. Hemendra Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. HHS Vulnerability Disclosure, Help 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. Mucoid degeneration of the ACL is a rare cause of knee pain.1-8) This lesion of the ACL was first reported by Kumar et al.3) in 1999. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). 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). 1. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. 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. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 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). Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. On clinical examination, the active range of motion showed a flexion deficit. Postoperative pain relief was reported in seven studies. (61years), which was the largest study and represented more than one third of the total patients included in this review. Khanna et al. Unable to process the form. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. 1. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. ACL Ganglion Cysts - Radsource 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 anterior cruciate ligament (ACL ). Bergin D, Morrison WB, Carrino JA et-al. Bookshelf Dietary management and various treatments Scanning and diagnostic . Knee Surg & Relat Res 33, 26 (2021). Methods: The minimum follow-up was 3 years. This may support the theory that it is a degenerative process. 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 . Terms and Conditions, The mean age of patients ranged from 31 to 78years. All nine studies assessed the outcome of arthroscopic debridement of MDACL. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. HHS Vulnerability Disclosure, Help Mucoid degeneration of ACL - Osteoporosis - inspire.com https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. Postoperative recovery was four weeks on average. Glossary of terms for musculoskeletal radiology. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. eCollection 2022 May-Jun. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. National Center for Biotechnology Information The extracted data were assessed for meta-analysis. Manage cookies/Do not sell my data we use in the preference centre. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. Disclaimer. Pan African Medical Journal. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Unauthorized use of these marks is strictly prohibited. PROSPERO. (PDF) Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration Before Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). Mucoid degeneration of the anterior cruciate ligament. This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. Initially, partial weightbearing is allowed. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. 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. Epub 2010 May 8. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. Knee Surg Sports Traumatol Arthrosc. PDF Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. 2006;69(9):44952. Bethesda, MD 20894, Web Policies ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. Preoperative magnetic resonance imaging (MRI) scan. Knee. statement and 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. Anterior cruciate ligament mucoid degeneration: a review of the sharing sensitive information, make sure youre on a federal 2007;15 (1): 73-86. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. Privacy Risk factors Predisposing factors include the following 1: aging Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. A 48-year-old-male patient presented with knee pain and limitation of motion. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Anterior cruciate ligament mucoid degeneration: Selecting the best 2011. MeSH 8600 Rockville Pike [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. Arch Orthop Trauma Surg. Shimasaki K, Yoshioka T, Kanamori A, Yamazaki M. Case Rep Orthop. When refering to evidence in academic writing, you should always try to reference the primary (original) source. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. Resnick D, Kransdorf MJ. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. Rehabilitation, orthophony, crenotherapy. Rajani AM, Shah UA, Mittal ARS, Gupta S, Garg R, Punamiya M. Knee Surg Relat Res. Degeneration in ACL Injured Knees with and without - PLOS The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. Conclusion: 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).
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