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. . I have persistent pain in the back of that knee that is exacerbated by walking and bending it. PubMed On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Knee Surg Sports Traumatol Arthrosc. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. 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 total number of patients with symptomatic instability was 18 out of 288 (6%). Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Fourteen knees (48%) had limited flexion, on average 97 degrees. Its signal is increased on all sequences. 1. 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 ). Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. Clipboard, Search History, and several other advanced features are temporarily unavailable. For non-comparative studies, this consists of eight questions. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. 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. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 8600 Rockville Pike The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. volume33, Articlenumber:26 (2021) Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. The origin of MDACL may be degenerative or traumatic. 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. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Disclaimer. Arthroscopic diagnostic criteria [7] are (1) continuous ACL fibres, (2) increased ACL volume, (3) yellowish-coloured material expressed on palpation and (4) loss of ACL synovial lining. 2008 Jun;24(6):642-9. doi: 10.1016/j.arthro.2008.02.004. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. Online ahead of print. The https:// ensures that you are connecting to the Ligaments hold our bones together and allow us to bend, twist, pivot and rapidly accelerate and decelerate and yet maintain the stability of our joints. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. California Privacy Statement, The mean age at the time of surgery was 57 years (range, 31 to 78 years). Hamdaoui and others published Le signe de la branche de cleri | Find, read and cite all the research you need on ResearchGate 8600 Rockville Pike Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. [Diagnosis and treatment of anterior cruciate ligament cysts]. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. 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 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. Epub 2010 May 8. https://doi.org/10.1007/s00167-012-1991-9, McIntyre J, Moelleken S, Tirman P (2001) Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. eCollection 2013. No treatment is usually required. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. Online ahead of print. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. It is a chronic degenerative change of a bulky ACL that may lead to notch . Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. sharing sensitive information, make sure youre on a federal Epub 2008 Dec 17. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. 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 . MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination [7]. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Characteristic: "celery stalk" appearance. sharing sensitive information, make sure youre on a federal Twelve partial and 17 total resections were performed. #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Methods: The minimum follow-up was 3 years. Orthopedics; anterior cruciate ligament; arthoscopy. government site. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. Federal government websites often end in .gov or .mil. official website and that any information you provide is encrypted [Effectiveness of bone-anterior cruciate ligament-bone allograft in reconstruction of anterior cruciate ligament under arthroscope]. 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. Before government site. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Bergin et al. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. 2018. http://journals.sagepub.com/doi/10.1177/2325967118786930, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. 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. Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. An official website of the United States government. J Clin Epidemiol 62(10):10061012. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). Sweed, T., Mussa, M., El-Bakoury, A. et al. HHS Vulnerability Disclosure, Help It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. 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. 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 examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Three reviewers (an experienced librarian and two of the authors) independently searched these databases. Level of Evidence: Level IV. Method. 8600 Rockville Pike 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). -. Keywords: Case report: and transmitted securely. Anterior Cruciate Ligament, is an important structure of the knee joint. Anterior knee pain is the more common complaint. 2011. Before Bookshelf 2007;15 (1): 73-86. 2023 BioMed Central Ltd unless otherwise stated. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. The clinical presentation is one of posterior pain with limited flexion. The rate of simultaneous meniscectomy ranged from 13 to 44%. Download Citation | On Feb 1, 2023, O.R. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. 2012;4 (2): 167-70. . Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. in 1999 [1]. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. 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. MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. Postoperative clinical laxity was common, however, symptomatic instability was not. What is myxoid degeneration treatment? Anterior cruciate ligament mucoid degeneration. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee J Arthrosc Joint Surg 3(1):2833. Conclusions: This site needs JavaScript to work properly. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. In this systematic review we found that arthroscopic debridement resulted in good pain relief and improved range of motion and clinical outcome scores. [6], in 62% of patients (18 of 29) in the study of Lintz et al. At the time the article was created Frank Gaillard had no recorded disclosures. A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Keywords: Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Generally, we know little about this condition. -, Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Would you like email updates of new search results? report that one patient had ACL reconstruction simultaneously after the ACL debridement. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Disclaimer. Skelet Radiol 30(6):312315. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Magn Reson Imaging Clin N Am. This makes it difficult to relate the improvement of symptoms to ACL debridement. Clin Orthop Surg. 2011 Mar;25(3):262-5. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. 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. J Knee Surg. Another theory is the synovial theory whereby a pouch of synovium herniates and is subsequently filled with synovium [2]. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. 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 ]. 2004;182(5):12831287. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. 2011 Jun;25(6):650-2. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. ACL tears don't heal as such. Epub 2018 Aug 22. The extracted data were assessed for meta-analysis. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. NCI CPTC Antibody Characterization Program. Preoperative and postoperative results of eleven patient were compared. J Chin Med Assoc. government site. Arthroscopic findings. Conclusion: 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. 8600 Rockville Pike Careers. Fig. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. 2013;15(1). Level of evidence: Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Would you like email updates of new search results? A total of 313 knees in 292 patients were included. All nine studies were case series; six were retrospective and three were prospective studies. Check for errors and try again. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. : A Meta-Analysis. What you feel (symptoms) You feel heaviness in knee joint. AJR Am J Roentgenol. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. This site needs JavaScript to work properly. 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). MeSH 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). 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. There was no mention in the other three studies [13, 15, 18] of whether other procedures were performed simultaneously. 1992;159(2):35760. 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. 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]. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. 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. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. PMC Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Arthroscopic findings. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. (10%) and highest in the study of Ventura et al. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. . 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. Eight studies showed postoperative improvement in range of motion, whereas Khanna et al. Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. The https:// ensures that you are connecting to the This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. Resnick D, Kransdorf MJ. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. 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. The pathogenesis remains controversial. 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). The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Dietary management and various treatments Scanning and diagnostic . Indian J Orthop 48(2):197202. Arch Orthop Trauma Surg. The author(s) read and approved the final manuscript. Postoperative pain relief was reported in seven studies. and transmitted securely. 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. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. 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. Orthop Traumatol Surg Res. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Epub 2021 Nov 24. The mean follow up ranged from 13 to 72months. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Arthroscopic debridement of the ACL resulted in good pain relief and improved range of movement in all studies, with postoperative improvement in the knee scores. The retrospective study by Kim et al. Mucoid degeneration of ACL. Arthroscopy. The https:// ensures that you are connecting to the Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. See this image and copyright information in PMC. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. What causes mucoid degeneration of ACL? Clipboard, Search History, and several other advanced features are temporarily unavailable. 2006;69(9):44952. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. 1). None of the studies was a randomised controlled trial and none had a control group. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. 2007;90(3):1923. Knee Surg & Relat Res 33, 26 (2021). 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]. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19].