Unable to process the form. 2001;30(6):312315. Before Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. 2008;24(6):642649. This was lowest in the study of Cha et al. A long duration of non-specific knee pain in a patient should be evaluated with MRI. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. The .gov means its official. Knee Surgery, Sports Traumatology, Arthroscopy. National Library of Medicine Bergin et al. (B) Partial resection, MeSH Physiotherapy. PMC 2008 Jun;24(6):642-9. doi: 10.1016/j.arthro.2008.02.004. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Arthroscopic findings. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. 2007;90(3):1923. statement and That is usually the journal article where the information was first stated. 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. 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). J Sports Med Phys Fitness 48(4):483487, PubMed Disclaimer. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. Postoperative pain relief was reported in seven studies. . Bethesda, MD 20894, Web Policies Initially, partial weightbearing is allowed. 2011. https://doi.org/10.4103/0019-5413.128765, Article 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. The minimum follow-up was 3 years. government site. 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 systematic review. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. HHS Vulnerability Disclosure, Help Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. official website and that any information you provide is encrypted Therefore, indications for ACL resection must be carefully selected. 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. Postoperative recovery was four weeks on average. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. Method. Read More Created for people with ongoing healthcare needs but benefits everyone. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Intact fibers are best seen on T2WI. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . . 6. Careers. 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. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Instrumental treatment. reported the largest percentage of patients (27.5%) with a positive pivot test. sharing sensitive information, make sure youre on a federal 2011;19(3):408411. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. Reeducation. Bookshelf Federal government websites often end in .gov or .mil. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. 1. government site. 4. GG and AM interpreted the results and reviewed the manuscript. Chudasama CH, Chudasama VC, Prabhakar MM. 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. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. The mean follow up ranged from 13 to 72months. did not report on this. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Tamer Sweed. The purpose of this study was to investigate the outcome of management of MDACL by performing a systematic review of methods of treatment that have been reported. Radiology. 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. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. 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. None of the studies was a randomised controlled trial and none had a control group. You can read more if you want. 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. Terms and Conditions, FOIA The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 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). Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. This site needs JavaScript to work properly. 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. 2004;182(5):12837. 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. They respond well to a judicious arthroscopic release of the ACL with notchplasty. The anterior cruciate ligament (ACL) is an important ligament in the knee. 8600 Rockville Pike We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. Instrumental treatment. Patients will . CAS Twelve partial and 17 total resections were performed. 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 is a chronic degenerative change of a bulky ACL that may lead to notch . The extracted data were heterogeneous in terms of outcome assessment. Categories were determined in accordance with the study of Ekhtiari et al. 2010 Jun 1;96(4):400-6. Individuals with mucoid degeneration of the ACL were excluded. 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). To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. -. International Journal of Orthopaedics. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. Advanced MR imaging of the cruciate ligaments. Epub 2011 Feb 18. In the nine included studies, four different scores were used for outcome assessment. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Disclaimer. Any discrepancy was resolved by the senior author. 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). Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. 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 . Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. MM and A performed the literature search, and data analysis. All rights reserved. (2018) Radiology. 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). Level of Evidence: Level IV. 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. government site. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. 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 HHS Vulnerability Disclosure, Help 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. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. ACL tears don't heal as such. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). official website and that any information you provide is encrypted -, Fealy S, Kenter K, Dines JS, Warren RF. Indian J Orthop. Results: 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]. Four studies reported only postoperative scores, which were comparable to those in other studies. Knee Surg Sports Traumatol Arthrosc. as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. Three reviewers (an experienced librarian and two of the authors) independently searched these databases. These appearances must be differentiated from mucoid degeneration of the intact ACL. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). Mucoid degeneration of ACL. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. MeSH The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . Federal government websites often end in .gov or .mil. 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. This is a rare pathological condition, in which, there is increased signal from within the ligament. -, 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. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The appearance can mimic acute or chronic interstitial partial tears of the ACL. California Privacy Statement, Manage cookies/Do not sell my data we use in the preference centre. to 44% in the study of Cha et al. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. The mean MINORS score was 9.5 (range 412). (10%) and highest in the study of Ventura et al. Conclusion: In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. Postoperative pain relief ranged from 53.8 to 95%. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2001;17(9):E37. Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.817.97 years (42-74 years).
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