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This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). 2009. 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. The minimum follow-up was 3 years. 2011 Aug 1;19(8):1326-33. 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 mean age at the time of surgery was 57 years (range, 31 to 78 years). The .gov means its official. The pathogenesis remains controversial. 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. CAS Mucoid degeneration of the anterior cruciate ligament. Bergin et al. FOIA Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-3615, Case 11: with Hoffa fat pad ganglion cyst, Case 12: tibial nerve schwannoma and ACL mucoid degeneration, Case 1: Complete ACL tear and meniscal tears, Case 2: Anomalous insertion of the medial meniscus, View Frank Gaillard's current disclosures, see full revision history and disclosures, anterior cruciate ligament ganglion cysts, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Mucoid degeneration of the anterior cruciate ligament, congenital or acquired synovial tissue entrapment between ACL fibers. Knee Surg Sports Traumatol Arthrosc. The site is secure. Radiology. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Method. Intact fibers are best seen on T2WI. Roberts CC, Towers JD, Spangehl MJ et-al. PubMedGoogle Scholar. 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). Risk factors Predisposing factors include the following 1: aging Before National Library of Medicine That is usually the journal article where the information was first stated. Disclaimer. However, MDACL is asymptomatic in most patients. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. An official website of the United States government. Mucoid degeneration of the anterior cruciate ligament: a case report. 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. and transmitted securely. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. and transmitted securely. AJR Am J Roentgenol. Arthroscopy. Mucoid degeneration of the anterior cruciate ligament. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. PMC (A) Bulging of the hypertrophied anterior cruciate ligament. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. volume33, Articlenumber:26 (2021) 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Orthopedics; anterior cruciate ligament; arthoscopy. IV (retrospective cohort study). The site is secure. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. No reconstruction was performed at the same time. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Unauthorized use of these marks is strictly prohibited. HHS Vulnerability Disclosure, Help The ligament is mainly responsible for restraining anterior translation of knee. At the time the article was last revised Dai Roberts had no recorded disclosures. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Arthroscopy. https://doi.org/10.1016/j.arthro.2008.02.004, Morice A, Coupry A, Lintz F, Robert H (2013) Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Fig. Results: 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. 8600 Rockville Pike 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. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. It may lead to knee pain. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Physiotherapy. 2008;24(6):642649. "Traumatic theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. This is a rare pathological condition, in which, there is increased signal from within the ligament. What causes mucoid degeneration of ACL? J Knee Surg. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. 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. Physical therapy typically begins 7-10 days after the procedure. in 1999 [1]. Copyright 2010 Elsevier Masson SAS. (10%) and highest in the study of Ventura et al. Disclaimer. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. reported the largest percentage of patients (27.5%) with a positive pivot test. -Evaluated and planned treatment protocol in accordance with physician. Orthop Traumatol Surg Res. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Arthroscopy. https://doi.org/10.4103/0019-5413.128765, Article 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. Accessibility Accessibility 2001;17(9):E37. Magn Reson Imaging Clin N Am. 2011 Mar;25(3):262-5. and transmitted securely. Privacy Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. Federal government websites often end in .gov or .mil. PMC Bookshelf The https:// ensures that you are connecting to the The cause is not really known, but patients usually do not complain of instability. 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. 1. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. ADVERTISEMENT: Supporters see fewer/no ads. Before The need for simultaneous or delayed ACL reconstruction should be discussed with patients in case total resection of the ACL is to be performed, particularly in young active patients. mucoid degeneration acl symptoms. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Keywords: Noninfiltrating synovial cysts of the ACL were excluded. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Epub 2010 May 8. All nine studies were case series; six were retrospective and three were prospective studies. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A total of 313 knees in 292 patients were included in the nine studies. 2004;182 (5): 1283-7. Four studies reported only postoperative scores, which were comparable to those in other studies. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. Pan African Medical Journal. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. Epub 2010 May 8. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. MeSH Careers. Physical Therapy. Conclusion: Treatment of ACL mucoid degeneration by this modality is effective in preventing recurrence, post-operative laxity and provides better functional outcome compared to the classical partial resection of the degenerated ACL. . The .gov means its official. 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. Postoperative pain relief ranged from 53.8 to 95%. (B) Partial resection, MeSH Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). The appearance can mimic acute or chronic interstitial partial tears of the ACL. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. Mucoid degeneration of the anterior cruciate ligament. 2004;182(5):12831287. No treatment is usually required. 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. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. California Privacy Statement, [6], in 62% of patients (18 of 29) in the study of Lintz et al. 2. The extracted data were assessed for meta-analysis. Postoperative clinical laxity was common, however, symptomatic instability was not. [Diagnosis and treatment of anterior cruciate ligament cysts]. Six studies reported using the pivot shift test; unsurprisingly, Lintz et al. Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. PMC Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. Epub 2021 Mar 8. 287 (3): 912-921. Knee. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Download Citation | On Feb 1, 2023, O.R. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. bling. in 1999 [ 1 ]. 2007;15 (1): 73-86. CAS 2007;245 (3): 916-7. Tamer Sweed. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. Advanced MR imaging of the cruciate ligaments. official website and that any information you provide is encrypted 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. J Clin Epidemiol 62(10):10061012. Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? 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. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and MethodsBetween December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis . On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Knee Surg Sports Traumatol Arthrosc 21(3):658663. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. and Ventura 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 Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. ACL tears don't heal as such. International Journal of Orthopaedics. Arthroscopic findings. Conclusions. Please enable it to take advantage of the complete set of features! Average patient age was 49 (22 to 68) years. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. Online ahead of print. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Background: Please enable it to take advantage of the complete set of features! National Library of Medicine The appearance can mimic acute or chronic interstitial partial tears of the ACL. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. The .gov means its official. Symptomatic ACL mucoid degeneration in middle-age athletes. Epub 2011 Feb 18. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. 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. The aim of this study was to detail the clinical, radiological, arthroscopic, and pathological findings of mucoid degeneration of the anterior cruciate ligament and report the clinical outcomes following arthroscopic treatment. Morice et al. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. ACL debridement was partial in all studies except for those by Lintz et al. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. Unable to load your collection due to an error, Unable to load your delegates due to an error. J Bone Joint Surg Br. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Symptoms included limited range of motion (ROM) and posterior knee pain. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Knee Surg Sports Traumatol Arthrosc. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Would you like email updates of new search results? Hide glossary Glossary. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. Epub 2018 Jan 2. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Imaging: Plain radiographs You can read more if you want. Disclaimer. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Other theories include Degenerative theory- MD could occur due to ageing.[3]. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. MeSH The inclusion criteria for this study were (1) studies including symptomatic patients with mucoid degeneration of the ACL, (2) studies of 10 or more patients, (3) a minimum of 6months follow up and (4) patients treated conservatively or surgically (arthroscopic debridement with or without simultaneous ACL reconstruction). Case report: All patients (100%, n=11) reported an improvement in pain. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Bookshelf 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 . 2006 Sep;69(9):449-52. doi: 10.1016/S1726-4901(09)70290-4. Eight studies showed postoperative improvement in range of motion, whereas Khanna et al. 2011. Reeducation. Anterior knee pain is the more common complaint. Patients and methods: Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). The retrospective study by Kim et al. The anterior cruciate ligament (ACL) is an important ligament in the knee. Clipboard, Search History, and several other advanced features are temporarily unavailable. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Mucinous material within the substance of ACL produces pain and limited motion in the knee. 2023 BioMed Central Ltd unless otherwise stated. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 8600 Rockville Pike 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. Two patients uderwent secondary ligamentoplasty. and transmitted securely. The authors declare that they have no competing interests. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. 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).