Preoperative and postoperative results of eleven patient were compared. Epub 2010 May 8. Imaging: Plain radiographs Individuals with mucoid degeneration of the ACL were excluded. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. -. sharing sensitive information, make sure youre on a federal Terms and Conditions, Indian J Orthop. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Instrumental treatment. Average postoperative International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were 71.2 (42.5 to 92.0) and 78.2 (26.4 to 99). What you feel (symptoms) You feel heaviness in knee joint. ADVERTISEMENT: Supporters see fewer/no ads. W B Saunders Co. (2005) ISBN:0721602703. PMC J Bone Joint Surg Br. Roberts CC, Towers JD, Spangehl MJ et-al. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Knee Surg Sports Traumatol Arthrosc. Glossary of terms for musculoskeletal radiology. National Library of Medicine Clipboard, Search History, and several other advanced features are temporarily unavailable. sharing sensitive information, make sure youre on a federal 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. 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 ]. Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. 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). Resnick D, Kransdorf MJ. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. 2018;4(4):875-80. 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. This was lowest in the study of Cha et al. The clinical presentation is one of posterior pain with limited flexion. 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]. Cookies policy. The site is secure. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. Mucoid degeneration of the anterior cruciate ligament. [Diagnosis and treatment of anterior cruciate ligament cysts]. 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. 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. 2010 Jun 1;96(4):400-6. https://doi.org/10.4103/0019-5413.101037, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligament management and functional outcome of 18 cases. A total of nine studies were eligible for review. A total of 313 knees in 292 patients were included in the nine studies. Hide glossary Glossary. Unable to load your collection due to an error, Unable to load your delegates due to an error. Postoperative recovery was four weeks on average. On clinical examination, the active range of motion showed a flexion deficit. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. government site. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Disclaimer. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. Epub 2011 Feb 18. Mucoid degeneration of the anterior cruciate ligament. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. What is Anterior Cruciate Ligament Mucoid Degeneration? have described the following MRI criteria [4]: (1) high signal intensity in the T1 and T2 sequences, (2) increased ACL volume and (3) continuous fibres of ACL shown in the T2 sequence. FOIA 2011 Aug 1;19(8):1326-33. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. 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. See this image and copyright information in PMC. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. You can read more if you want. Orthop Traumatol Surg Res. Indian J Orthop 46(5):561565. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. 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. 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. 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. A long duration of non-specific knee pain in a patient should be evaluated with MRI. The appearance can mimic acute or chronic interstitial partial tears of the ACL. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. Arthroscopy. 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). Postoperative pain relief ranged from 53.8 to 95%. (B) Partial resection, MeSH 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. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. Keywords: The site is secure. (100%). 2. The anterior cruciate ligament (ACL) is one of the more vital and more easily injured ligaments within our knee. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Postoperative clinical laxity was common, however, symptomatic instability was not. 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]. Bethesda, MD 20894, Web Policies Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Clin Orthop Surg. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. 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 . Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. This is basically an MRI diagnosis of expansion and increased signal of an intact ACL in a person with knee pain which is worse on knee flexion/bending. 2008;24(6):642649. Four studies reported only postoperative scores, which were comparable to those in other studies. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. (61years), which was the largest study and represented more than one third of the total patients included in this review. International Journal of Orthopaedics. Level of evidence: See this image and copyright information in PMC. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Bergin et al. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Three reviewers (an experienced librarian and two of the authors) independently searched these databases. No treatment is usually required. 2012;4 (2): 167-70. Copyright 2010 Elsevier Masson SAS. 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. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity that has been found in patients with pain and limited range of motion of the knee in association with a bulky ACL shown on magnetic resonance imaging (MRI). Arthroscopy. Methods: Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. Knee Surg & Relat Res 33, 26 (2021). Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. 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. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. This study concerns complete ACL resec statement and Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. However, symptomatic instability was not common. An official website of the United States government. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. PubMed Hypothesis: This makes it difficult to relate the improvement of symptoms to ACL debridement. PMC There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. 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. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Privacy A 48-year-old-male patient presented with knee pain and limitation of motion. Advanced MR imaging of the cruciate ligaments. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . Mucoid degeneration of ACL.
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