Mayo Clinic is a not-for-profit organization. J Arthosc 6:322, 1990. It is characterised by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the substance of ACL leading to thickening of the native ACL and its impingement on the lateral femoral condyle, femoral notch and PCL, consequently causing knee pain and limited motion. [5] and Chudasama etal. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. Mucoid degeneration of the anterior cruciate ligament (ACL) is a common pathology but is often unknown and underdiagnosed. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. Laskowski ER (expert opinion). Despite integrity and status of cruciates being paramount in a UKA, no study has evaluated the effect of debulking MD-ACL in this procedure. The appearance can mimic acute or chronic interstitial partial tears of the ACL. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. If left untreated, a small ACL tear will increase in size, causing more pain and increasing the laxity in the knee. Finally, the patients who underwent debulking had a better mean subjective patient satisfaction (9.830.37 versus 8.680.71) at the final follow-up at 2years (p<0.05) (Table 2). Mucoid degeneration of ACL. Common wrist ganglions include: dorsal wrist ganglion volar wrist ganglion volar retinaculum ganglion extensor retinaculum ganglion occult ganglion intraosseous ganglion mucous cyst In a 2007 study of patients in Glasgow whose foot lumps were removed surgically, 39 of 101 cases were ganglion cysts. [] found the incidence of mucoid degeneration in their study population to be 1.0%.Most of their reported cases were incidental findings without contributory symptoms. 2 Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM: Musculoskeletal MRI. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. 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. Conclusion: PRP can be used to improve the healing and strength ofa weakened ACL after partial debridement, but further research is needed to demonstrate its efficacy. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Generally, we know little about this condition. https://doi.org/10.1302/0301-620X.73B4.2071640, Pandit H, Gulati A, Jenkins C (2011) Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. c End-point of debulking when the surgeon can pass the arthroscopy hook between the medial cortex of lateral femoral condyle and lateral border of the native ACL effortlessly. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. The samples collected from the five hospitals were 122 (group A: 58; group B: 64), 68 (group A: 35; group B: 33), 94 (group A: 46; group B: 48), 83 (group A: 41; group B: 42) and 75 (group A: 36; group B: 39), respectively. Secondly, all the patients underwent the surgery and postoperative rehabilitation based on a standardized protocol which may limit the reproducibility of results if not adhered to. what causes mucoid degeneration of acl. > Follow SCIRP. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. In these patients, when UKA is coupled with debulking of the MD-ACL with a predetermined end point, a significant improvement in the overall ROM, rest pain, functional outcome scores and subjective satisfaction of the patient can be achieved. 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. Being a multicentric study involving five different surgeons, surgeon factors could potentially affect surgical procedure and clinical outcome, despite a predetermined endpoint for the debulking. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears . Score: 4.7/5 (45 votes) . -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Mucoid degeneration of anterior cruciate ligament (ACL). [7] have documented the presence of flexion contracture, we did not notice the same in any patient from the recruited sample size. Arthrosc Tech 7(5):e459e463. Let others know if this answer was helpful [5]. Get your query answered 24*7 only on | Practo Consult . Signs and symptoms: It usually affects middle aged and elderly people. These include pristine lateral and patellofemoral compartments, correctable varus deformity, less than 1015 of fixed flexion deformity, flexion of more than 100, and functionally intact collateral ligaments and cruciates [10,11,12,13,14,15]. . What is your diagnosis? Accessed Nov. 13, 2018. Patients will . The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. On inter-group comparison, the group in which debulking was done had better mean KSS and mean IKDC score at 2years of follow-up (p<0.05). Advertising revenue supports our not-for-profit mission. . Anterior and posterior cruciate ligament ganglion cysts are reported in the literature as being rare with an incidence of approximately 0.5% to 1%.1,2 However, in our experience, this entity is encountered more commonly, most often within the anterior cruciate ligament. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. 21 yrs old Male asked about Mucoid degeneration of ACL, 2 doctors answered this and 92 people found it useful. Am J Sports Med 29(5):600613. Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. b Immediate post-operative radiograph showing no posterior translation of femur compared with pre-operative radiograph. The results found improved functional scores and pain scores compared with preoperative levels. Accessed Nov. 13, 2018. What happens if you dont get surgery on a torn ACL? When considering a UKA in such a patient, a plethora of dilemmas may arise in the mind of an orthopaedic surgeon vis a vis preserving the MD-ACL at the cost of functional limitation, or debulking it and predisposing the UKA to failure owing to instability. With an increasing trend of UKA being performed worldwide, the role of addressing concomitant MD-ACL is vital in improving the overall outcome of the patient without causing any instability or implant failure, as shown in this study. (8a) Intraosseous extension of an ACL ganglion. Mucoid degeneration of the anterior cruciate ligament, International Knee Documentation Committee, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. As we age, the connections between the collagen fibers that make up the meniscus begin to deteriorate, causing failure of the structure and tears due to stresses in the joint. They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. Pre-operative and follow-up lateral radiographs of the patients who underwent debulking were analysed by a blinded radiologist and no posterior translation of the femur was noted, thereby confirming no instability caused by the debulking (Fig. Most older patients with meniscus tears can obtain relief from symptoms such as pain, swelling and decreased range of motion, and improve function, without surgery. (Tr. Mucoid degeneration of the ACL is a rare cause of knee pain in the middle-aged patient group, without knee instability. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. It is postulated that mucoid degeneration may be a predisposing factor to the formation of ACL ganglion cysts . Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. A total of 488 patients diagnosed with MD-ACL (clinically and radiologically) underwent surgery during this period, of which 46 patients (9.43%) were lost to the minimum 2-year follow-up criteria or to matching of groups. The rest of the surgery remained the same and all patients underwent mobile-bearing Oxford UKA. [20], Chudasama etal. On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. Despite maximising the factors involved between the two groups, as the sample size collection was done during two separate time periods and consecutive sampling was done instead of randomisation, there is a possibility of sampling bias. Correspondence to Arthroscopic surgeries are key hole surgeries for joint disorders. PubMed 308 Ventura et al. [4]showed high percentages of laxity post debulking of MD-ACL, a finding which would not allow a surgeon to carry out a UKA after the debulking. (2a) T1-weighted sagittal image demonstrates an enlarged, club-shaped anterior cruciate ligament (arrows). The ACL graft (arrow) is abnormally lax and demonstrates abnormally increased signal intensity, likely secondary to degeneration from chronic mechanical stress. Diagnosis is usually made on the MRI. 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 . 5 Stoller DW: Magnetic Resonance Imaging in Orthopaedics and Sports Medicine . The pathogenesis of mucoid degeneration is unclear, but injury, ganglion cysts, and degenerative process have been implicated as the most likely etiologic factors in the production of this change. Int J Sports Phys Ther 10(1):5261, PubMed American Journal of Sports Medicine. One MRI was reported as a possible ganglion cyst or mucoid degeneration of the ACL, whereas all others were reported as either partial or complete tears of the ACL. MD-ACL lies in the grey area of a stable, yet functionally limiting condition that has the propensity to become relatively unstable after undergoing debulking. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. The patients clinical history and symptoms do not support an ACL injury. 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. Grade 1A laxity on Lachmans test (less than 5mm translation with a firm end-point) was noted in 27 knees (11.95%) intra-operatively in group B or those who underwent debulking (nb=226), whereas a firm endpoint with no translation was noted in all of the remaining 199 knees (88.05%). UKA by itself improves the functional and clinical outcome of patients with medial compartment osteoarthritis. Knee Surg Sports Traumatol Arthrosc 21(3):658663. The first resembles ganglia in other periarticular locations, presenting as a discrete fluid signal cystic structure within the substance or on the surface of the ACL(5a).3 The second form has been likened to a celery stalk in appearance.4 The ACL demonstrates diffuse thickening containing ill-defined intraligamentous T2-hyperintensity, which splays the intact ACL fibers (6a). Close. Anterior cruciate ligament ganglion cyst with intraosseous extension. Rehabilitation, speech therapy, crenotherapy. We offer latest arthroscopic and minimally invasive single and double row rotator cuff repair in cases of rotator cuff tear. You can read more if you want. Connect with thousands of patients and caregivers for support, practical information, and answers. 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. 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. Paterno MV, et al. Arthroscopic debridement may help relieve the anterior knee pain. Ellman MB, et al. Anterior knee pain is the more common complaint. It can be secondary to trauma, or simply degeneration caused by meniscal injury, osteoarthritis or chondral damage [2]. ACL ganglion cyst occurs more frequently among relatively younger patients compared to mucoid degeneration. 3). Answered . A proton density-weighted coronal view from the same patient as seen in (A) and (B) reveals intraosseous ganglia (arrows) communicating with the ACL ganglion cyst (short arrow). Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but Both the groups were matched in terms of age, body mass index, pre-operative ROM, pre-operative International Knee Documentation Committee (IKDC) score [17] and pre-operative Knee Society score (KSS) [18]. https://doi.org/10.2214/ajr.182.5.18212835, Article An anteriorly protruding ganglion (arrow) arising from an ACL ganglion cyst (arrowheads) is well seen on a proton density-weighted sagittal image. The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This allows the doctor to see the knee structures more clearly. Intraosseous increased signal is present within the tibial spine deep to the posterior extent of the ACL insertion (arrowhead). This is done arthroscopically (arthroscopic/key hole surgery). This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. The abnormal sliding within the knee also can hurt cartilage. https://doi.org/10.1186/s10195-020-00551-x, Mulligan EP, McGuffie DQ, Coyner K, Khazzam M (2015) The reliability and diagnostic accuracy of assessing the translation endpoint during the lachman test. The portal can access those files and use them to remember the user's data, such as their chosen settings (screen view, interface language, etc. As per study population statistics, the prevalence of medial meniscus tears (29.64%) in this study were congruent to the rates found in studies by Srivastava etal. #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. This denoted adequate release of the impinging fibers against the lateral femoral condyle, femoral notch and PCL. Is this likely to cause my knee pain or can it be the compressed lumbar nerve or both? Google Scholar, Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. We describe Arthroscopic near total debridement of mucoid degenerated ACL in . Privacy J Bone Jt Surg [Br] 68-B:608609, Kang SN, Smith TO, De Rover WBS, Walton NP (2011) Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. Remote ligamentous trauma as well as mucinous degeneration associated with aging likely play a role in the development of cruciate cysts. The ligament can also tear due to work injuries or automobile accidents. A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. Hence, we targeted a minimum sample size of 400 patients. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. 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). was the primary surgeon and was responsible for the conceptualization, methodology, supervision, writing review and editing. Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. Contact us. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com.
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