Three reviewers (an experienced librarian and two of the authors) independently searched these databases. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). There is no consensus on treatment and evidence is scarce. Int J Curr Res Aca Rev 4(11):1824 http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI (2008) Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Please enable it to take advantage of the complete set of features! #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. Clinical outcome was reported using a variety of scores (the Lysholm and International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the visual analogue scale (VAS) score) in the different studies; these are summarized in Table 4. The https:// ensures that you are connecting to the Fig. Bergin et al. All rights reserved. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. Arthroscopy. The mean age at the time of surgery was 57 years (range, 31 to 78 years). 287 (3): 912-921. We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Arthroscopic debridement may help relieve the anterior knee pain. This appearance can mimic acute or chronic interstitial partial tears of the ligament. 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. These appearances must be differentiated from mucoid degeneration of the intact ACL. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. Arthroscopy. 2008;24(6):642649. PROSPERO. Skeletal Radiology. Clin Orthop Surg. Mucoid degeneration of the anterior cruciate ligament: Management and outcome.. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. 2. 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). Glossary of terms for musculoskeletal radiology. Case report: An official website of the United States government. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. J Arthrosc Joint Surg 3(1):2833. 1. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. 2007;15 (1): 73-86. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. 8600 Rockville Pike 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. A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. (Table 3). Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Epub 2011 Feb 18. 2 ). 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. The authors declare that they have no competing interests. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . Disclaimer. PubMed 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]. Sep 2017 - Feb 20186 months. Careers. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.4103/0019-5413.128765, Article 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. Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? Epub 2013 Aug 27. HHS Vulnerability Disclosure, Help Mucoid degeneration of the anterior cruciate ligament. official website and that any information you provide is encrypted Epub 2018 Jan 2. The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. CAS Bookshelf and Ventura et al. Arch Orthop Trauma Surg. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. Knee Surg Sports Traumatol Arthrosc. Chudasama CH, Chudasama VC, Prabhakar MM. Correspondence to Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Disclaimer. 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. 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. 3. Indian J Orthop 48(2):197202. Bookshelf The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. Arthroscopy. Bethesda, MD 20894, Web Policies The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. The patient presented with extension block of the knee. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Cookies policy. Khanna et al. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. Truncation means that the . [6], in 62% of patients (18 of 29) in the study of Lintz et al. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. 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. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Mucoid degeneration of the anterior cruciate ligament. Results: as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. Mucinous material within the substance of ACL produces pain and limited motion in the knee. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). Before did not report on this. Accessibility The total number of patients with symptomatic instability was 18 out of 288 (6%). Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. The ligament is mainly responsible for restraining anterior translation of knee. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. However, symptomatic instability was not common. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. Check for errors and try again. What is myxoid degeneration treatment? Method. Mucoid degeneration of ACL Justamom21 Feb 17, 2023 7:27 AM Among other conditions - osteoarthritis, osteopenia, spondylolisthesis- an MRI report showed "severe mucoid degeneration of the ACL" in my left knee. Online ahead of print. and transmitted securely. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. Preoperative magnetic resonance imaging (MRI) scan. Rehabilitation, speech therapy, crenotherapy. Conclusion: 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. 2006;69(9):44952. 2011 Jun;25(6):650-2. Knee Surg Sports Traumatol Arthrosc. Categories were determined in accordance with the study of Ekhtiari et al. CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported. 2. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. On clinical examination, the active range of motion showed a flexion deficit. [Diagnosis and treatment of anterior cruciate ligament cysts]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. Federal government websites often end in .gov or .mil. 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. There was strong association between degenerative changes and MDACL (82% having chondral and 69% meniscal lesions), which might suggest that MDACL is a degenerative process. 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. To our knowledge, this is the first systematic review to look into the results of the management of MDACL. sharing sensitive information, make sure youre on a federal Orthop Traumatol Surg Res 99(6):693697, Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS (2016) Mucoid degeneration of the anterior cruciate ligament: partial arthroscopic debridement and outcomes. Questions just answered: mucoid degeneration of acl physiotherapy. 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. 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. Mucoid degeneration of both ACL and PCL. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). This bicentric, retrospective cohort study with an average follow-up of 6years involved 27 patients (29 knees) presenting with symptomatic ACL mucoid degeneration validated by magnetic resonance imaging (MRI). 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. 2007;245 (3): 916-7. statement and Level of Evidence: Level IV. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Eight studies showed postoperative improvement in range of motion, whereas Khanna et al. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. in 1999 [ 1 ]. I get PT and acupuncture, have had several epidural injections, and am trying hard to avoid osteoporosis meds (was on bisphosphonates for many years many years ago) as well as spinal fusion. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Besides, the patient may also have trouble in moving. For non-comparative studies, this consists of eight questions. 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. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. 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]. sharing sensitive information, make sure youre on a federal Springer Nature. Mucoid cystic degeneration of the cruciate ligament. Level of evidence: 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. https://doi.org/10.1302/0301-620X.81B2.0810304, Article A total of nine studies were eligible for review. 2018;4(4):875-80. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. Epub 2011 Feb 18. 2011 Mar;25(3):262-5. Postoperative recovery was four weeks on average. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine Instrumental treatment. 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. 2010 Jun 1;96(4):400-6. 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. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). The anterior cruciate ligament (ACL) is an important ligament in the knee. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. All patients (100%, n=11) reported a good to very good surgery satisfaction. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Advanced MR imaging of the cruciate ligaments. J Bone Joint Surg Br. https://doi.org/10.1007/s002560100336, Narvekar A, Gajjar S (2004) Mucoid degeneration of the anterior cruciate ligament. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Mucoid degeneration of the anterior cruciate ligament. 2021 Sep;50(9):1837-1843. doi: 10.1007/s00256-021-03750-7. https://doi.org/10.1007/s00167-011-1433-0, Article Would you like email updates of new search results? Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. 1. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. At the time the article was created Frank Gaillard had no recorded disclosures. Chudasama et al. 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. . Preoperative magnetic resonance imaging (MRI), Fig. Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. official website and that any information you provide is encrypted Indian J Orthop 46(5):561565. volume33, Articlenumber:26 (2021) Imaging: Plain radiographs Preoperative and postoperative results of eleven patient were compared. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. Please enable it to take advantage of the complete set of features! It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. Federal government websites often end in .gov or .mil. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. In the nine included studies, four different scores were used for outcome assessment. reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. . If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. Unauthorized use of these marks is strictly prohibited. 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). A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. 8600 Rockville Pike The origin of MDACL may be degenerative or traumatic. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. Roberts CC, Towers JD, Spangehl MJ et-al. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Introduction: Physiotherapy. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. sharing sensitive information, make sure youre on a federal Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Please enable it to take advantage of the complete set of features! 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. HHS Vulnerability Disclosure, Help The minimum follow-up was 3 years. 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). Average patient age was 49 (22 to 68) years. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Epub 2011 Feb 18. FOIA However, in most studies a proportion of patients simultaneously underwent other arthroscopic procedures for associated pathological knee conditions (44% meniscectomies in the study of Cha et al.). Bone and joint imaging. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. Knee Surg Sports Traumatol Arthrosc. Bethesda, MD 20894, Web Policies The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. J Chin Med Assoc. 2001;17(9):E37. Accessibility Clipboard, Search History, and several other advanced features are temporarily unavailable. CAS Arthroscopic findings. ACL tears don't heal as such. 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. Therefore, indications for ACL resection must be carefully selected. TS designed the project, literature search and wrote the manuscript. J Orthop. The aetiology of MDACL is not clearly understood. 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 ). Other theories include Degenerative theory- MD could occur due to ageing.[3]. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Cho SD, Youm YS, Lee CC et-al. 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. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. All nine studies were case series; six were retrospective and three were prospective studies. The .gov means its official. government site. 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. 2018 Apr;34(4):1054-1059. doi: 10.1016/j.arthro.2017.10.039. 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). It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. Knee Surg Sports Traumatol Arthrosc. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 2011. Mucoid degeneration of the anterior cruciate ligament. The cause is not really known, but patients usually do not complain of instability. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Physical Therapy. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Physical therapy typically begins 7-10 days after the procedure. 2023 BioMed Central Ltd unless otherwise stated. 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). In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). and transmitted securely. Patients will . The clinical presentation is one of posterior pain with limited flexion. The https:// ensures that you are connecting to the International Journal of Orthopaedics. 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.
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mucoid degeneration of acl physiotherapy