The origin of MDACL may be degenerative or traumatic. 1999;81(2):304305. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Arthroscopy. Anterior Cruciate Ligament, is an important structure of the knee joint. PubMedGoogle Scholar. . Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Mucoid cystic degeneration of the cruciate ligament. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the 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. Sep 2017 - Feb 20186 months. Accessibility None of the studies was a randomised controlled trial and none had a control group. Knee Surg Sports Traumatol Arthrosc. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Clin Orthop Surg. Patients will . 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). Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Fourteen knees (48%) had limited flexion, on average 97 degrees. In six of the nine studies [6, 14, 16,17,18], arthroscopic debridement of the ACL was associated with simultaneous partial meniscectomy; this ranged from 13% in the study of Morice et al. 2007;15 (1): 73-86. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. The https:// ensures that you are connecting to the Arthroscopy. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. 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 "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. Two patients uderwent secondary ligamentoplasty. FOIA Federal government websites often end in .gov or .mil. In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. 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. 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. (100%). 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. Arthroscopy 20(2):141146. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. ADVERTISEMENT: Supporters see fewer/no ads. What Is Mucoid Degeneration of the ACL? See this image and copyright information in PMC. Imaging: Plain radiographs Arthroscopic debridement may help relieve the anterior knee pain. Conclusions: Background: The extracted data were assessed for meta-analysis. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. bling. Epub 2010 May 8. Level of evidence: Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. 4. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. The site is secure. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. PMC Arch Orthop Trauma Surg. Questions just answered: mucoid degeneration of acl physiotherapy. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Arthroscopy. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. The site is secure. 2011. Bethesda, MD 20894, Web Policies Seven of the nine studies reported using the Lachman test to check postoperative ACL laxity. CAS Characteristic: "celery stalk" appearance. It results in postoperative laxity, but rarely in frank instability. Anterior cruciate ligament mucoid degeneration. Hypothesis: the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. The aetiology of MDACL is not clearly understood. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Indian J Orthop. National Library of Medicine 2006;69(9):44952. What you feel (symptoms) You feel heaviness in knee joint. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. Epub 2008 Apr 18. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. 2. 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. 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. J Sports Med Phys Fitness 48(4):483487, PubMed Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. 2004;182(5):12831287. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). 2008;24(6):642649. AJR Am J Roentgenol. This makes it difficult to relate the improvement of symptoms to ACL debridement. In that case, mucoid degeneration can be extruded from the ligament and will be removed in the saline flow. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. [18] did not comment on an association between MDACL and chondral or meniscal lesions: after the exclusion of that report, the total number of patients with associated chondral lesions was 226 out of 275 patients (82%) and 190 patients had meniscal lesions (69%). Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. Clipboard, Search History, and several other advanced features are temporarily unavailable. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. : A Meta-Analysis. Symptoms included limited range of motion (ROM) and posterior knee pain. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Accessed 1 Mar 2021. This appearance can mimic acute or chronic interstitial partial tears of the ligament. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Copyright 2010 Elsevier Masson SAS. Knee Surg Sports Traumatol Arthrosc. The retrospective study by Kim et al. Bethesda, MD 20894, Web Policies 2. Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. Physical therapy typically begins 7-10 days after the procedure. . (A) Bulging of, Fig. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. PubMed The extracted data were heterogeneous in terms of outcome assessment. PMC Mucoid degeneration of the anterior cruciate ligament. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. statement and Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Preoperative magnetic resonance imaging (MRI), Fig. 2001;30(6):312315. This may support the theory that it is a degenerative process. Meniscectomy was undertaken in 11 cases (41%). Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. (48.2% (14/29 patients) with symptomatic instability), which may be due to the large number of patients with total resection of the ACL (58.6% (17 out of 29 patients)) (Table 4). Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. Epub 2021 Mar 8. There was strong association with chondral lesions and meniscal tears. Any discrepancy was resolved by the senior author. HHS Vulnerability Disclosure, Help Sweed, T., Mussa, M., El-Bakoury, A. et al. Physiotherapy. 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. 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). Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. in this condition your acl (anterior cruciate ligament) filled with jelly like material and it thickened so space in intercondylar resion of knee joint is reduced. 1173185. 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. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. Its signal is increased on all sequences. All nine studies were case series; six were retrospective and three were prospective studies. Skeletal Radiol. 8600 Rockville Pike Knee Surg Sports Traumatol Arthrosc 21(3):658663. 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. -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. 2001;17(9):E37. However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. The https:// ensures that you are connecting to the We herein describe a case of PCL mucoid degeneration presented with secondary ACL . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Therefore, indications for ACL resection must be carefully selected. The https:// ensures that you are connecting to the Clin Orthop Surg. This study concerns complete ACL resec Mucoid degeneration of the anterior cruciate ligament. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. 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. Postoperative pain relief was reported in seven studies. The authors declare that they have no competing interests. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. 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. Online ahead of print. Keywords: 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 . Individuals with mucoid degeneration of the ACL were excluded. Dietary management and various treatments Scanning and diagnostic . 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]. Twelve partial and 17 total resections were performed. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Therefore, indications for ACL resection must be carefully selected. 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. This site needs JavaScript to work properly. J Bone Joint Surg Ser B 81(2):304305. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. PubMed 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 . 1. official website and that any information you provide is encrypted Epub 2018 Jun 13. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. ACL debridement was partial in all studies except for those by Lintz et al. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. Conclusion: Discussion: Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. All patients (100%, n=11) reported a good to very good surgery satisfaction.

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