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Arch Orthop Trauma Surg. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. In the nine included studies, four different scores were used for outcome assessment. 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. 2011. (10%) and highest in the study of Ventura et al. Am J Roentgenol 182(5):12831287. Clin Orthop Surg 10(3):307314. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. 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. It may lead to knee pain. ACL tears don't heal as such. 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. 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. . An official website of the United States government. An official website of the United States government. CAS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. Federal government websites often end in .gov or .mil. Intact fibers are best seen on T2WI. government site. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. What you feel (symptoms) You feel heaviness in knee joint. Read More Created for people with ongoing healthcare needs but benefits everyone. 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. HHS Vulnerability Disclosure, Help Along with that, it also controls the internal rotation. statement and Arthroscopic findings. Arch Orthop Trauma Surg. eCollection 2013. Generally, we know little about this condition. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. All nine studies included patients with symptomatic MDACL confirmed by MRI (Table3). 2013;15(1). Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. The .gov means its official. GG and AM interpreted the results and reviewed the manuscript. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Individuals with mucoid degeneration of the ACL were excluded. Anterior cruciate ligament mucoid degeneration. Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. 2007;90(3):1923. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physical Therapy. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. Mucoid degeneration of the anterior cruciate ligament. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. Bethesda, MD 20894, Web Policies Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. J Chin Med Assoc. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. Conclusions. Conclusions: Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. bling. Instrumental treatment. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Seventeen females (67%) and eight males (33%) were included in the final analysis. The purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported. Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2018 Aug 22. FOIA It results in postoperative laxity, but rarely in frank instability. By using this website, you agree to our Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. 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. 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). Reeducation. . Reeducation. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. 2011 Aug 1;19(8):1326-33. 3. Epub 2013 Aug 27. 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. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Tamer Sweed. Cookies policy. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. Federal government websites often end in .gov or .mil. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. 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. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. Federal government websites often end in .gov or .mil. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. J Orthop. 1992;159(2):35760. The pathogenesis remains controversial. Chudasama CH, Chudasama VC, Prabhakar MM. 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. Signal intensity of the anteromedial bundle (AMB) or posterolateral bundle (PLB) graft standardized to the intensity of the PCL was defined as signal intensity ratio (SIR). Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. J Orthop. The anterior cruciate ligament (ACL) is an important ligament in the knee. Mucoid degeneration of the anterior cruciate ligament. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. 4. Hypothesis: Conditions that resembles the clinical findings are: Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. The origin of MDACL may be degenerative or traumatic. 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. (A) Bulging of, Fig. Disclaimer. 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. Categories were determined in accordance with the study of Ekhtiari et al. 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 Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. 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. Accessibility Unauthorized use of these marks is strictly prohibited. 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. Keywords: 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. 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 ]. Rehabilitation, orthophony, crenotherapy. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. and transmitted securely. Fourteen knees (48%) had limited flexion, on average 97 degrees. official website and that any information you provide is encrypted Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Introduction: (A) Bulging of the hypertrophied anterior cruciate ligament. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. official website and that any information you provide is encrypted 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. eCollection 2022 May-Jun. PubMed Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. Google Scholar, Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D (2011) Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Clipboard, Search History, and several other advanced features are temporarily unavailable. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. This ranged from 90 to 95% in all studies, except in the report by Kim et al., where only 53.8% of patients (57/106) had complete pain relief after surgery. #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. All nine studies were case series; six were retrospective and three were prospective studies. 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]. Epub 2018 Jun 13. -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, most pronounced at 6-7 and small disc herniations at 5-6 and C4-5, with slight interval progression at 5-6. . Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Indian J Orthop. The mean MINORS score was 9.5 (range 412). The mean follow up ranged from 13 to 72months. [17] do not mention whether any patients underwent biopsy (Table 3). Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. 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. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Bookshelf AJR Am J Roentgenol. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. (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). Rehabilitation, speech therapy, crenotherapy. The .gov means its official. ADVERTISEMENT: Supporters see fewer/no ads. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Please enable it to take advantage of the complete set of features! The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Knee Surg Sports Traumatol Arthrosc. Provided by the Springer Nature SharedIt content-sharing initiative. Tissue biopsy was performed in 85% of patients (58 of 68) in the study of Cha et al. The minimum follow-up was 3 years. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. Epub 2010 May 8. Symptomatic ACL mucoid degeneration in middle-age athletes. and transmitted securely. 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. official website and that any information you provide is encrypted Ligaments are very tough, fibrous tissue structures. Bookshelf Before 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. Resnick D, Kransdorf MJ. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. 287 (3): 912-921. A 48-year-old-male patient presented with knee pain and limitation of motion. Cho SD, Youm YS, Lee CC et-al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Each study was scored 02 on each question, with a global ideal score of 16. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. Postoperative pain relief was reported in seven studies. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid There is no consensus on treatment and evidence is scarce. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). International Journal of Orthopaedics. A posterior approach will allow for the detection of changes by probing the ligament and mucoid material can be expressed. 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. The mean follow up ranged from 13 to 72months. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. These appearances must be differentiated from mucoid degeneration of the intact ACL. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. Google Scholar, Chudasama CH, Chudasama VC, Prabhakar MM (2012) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Online ahead of print. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. An official website of the United States government. FOIA Therefore, indications for ACL resection must be carefully selected. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores.