: tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. It also prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses [1]. Answered . Skeletal Radiol 2001 Jun; 30(6): 312-5. PubMedGoogle Scholar. Various techniques have been proposed for the debulking of MD-ACL including arthroscopic debridement using shaver or radiofrequency ablation, with or without notchplasty, that have shown to give good clinical results [8, 19]. Flowchart representation of selection process of sample size, intervention process and outcome assessment. They cross each other to form an X with the anterior cruciate ligament in front and the posterior cruciate ligament in back. Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Management of mucoid degeneration of the anterior cruciate ligament: a systematic . Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. Its function is to stabilize the knee while bending and rotating; the ACL also keeps the knee from shifting out of place or moving anteriorly (toward the front) with pivoting activities. A case of mucoid degeneration of the anterior cruciate ligament (ACL) is reported based on specific imaging features on MRI. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. J Clin Med 10(2):315. https://doi.org/10.3390/jcm10020315, Article https://doi.org/10.4103/0019-5413.101037, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J (2018) Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. These cysts have a variable MR appearance and are not always confined to the substance of the ligament. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Although arthroscopic resection of the degenerated ACL is the treatment of choice following the failure of conservative management, the extent of the excision and subsequent ACL reconstruction for . https://doi.org/10.2214/ajr.182.5.18212835, Article Did you hear a loud pop or feel a "popping" sensation? https://doi.org/10.1177/03635465010290051301, Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. This study showed that the patients who underwent debulking had statistically superior knee function, lesser rest pain and greater satisfaction rates at 2years of follow-up compared with those in whom MD-ACL was not debulked. 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. However, in the case of mucoid degeneration . PubMed Central American Journal of Sports Medicine. https://doi.org/10.1302/0301-620X.81B2.0810304, Article . [] 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. Patient is advised to do exercises to get movement and strength again following surgery. Mucoid degeneration of the anterior cruciate ligament (ACL) is a common pathology but is often unknown and underdiagnosed. Only mobile-bearing UKA design was used in all the patients; hence the findings may differ in patients undergoing UKA with different implant designs such as fixed-bearing UKAs. No writing assistance was utilized in the production of this manuscript. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Setback to comeback: Twin sisters return to the basketball court after ACL tears, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, NSF Certified for Sport Nutritional Supplements. 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. All authors read and approved the final manuscript. Clin Orthop Relat Res 248:1314, Hotchen AJ, Melton JTK (2018) Radiofrequency ablation for mucoid degeneration of the anterior cruciate ligament. They assessed the stability of the joint with the Lachman test intra-operatively, confirming it to be either grade zero or one, with firm end point, before commencing with the UKA [16]. When the arthroscopy hook was attempted to be passed between the lateral femoral condyle and the lateral aspect of the ACL, it was noticed that the impinging fibers of the mucoid ACL blocked its passage, thereby not allowing the hook to be passed between the lateral femoral condyle and the lateral aspect of the ACL, which is otherwise possible in cases with normal ACL. . The end point was ascertained to be when the surgeon could pass a hook between the medial cortex of the lateral femoral condyle and the lateral border of the remaining ACL. These ganglia consist of myxoid material. Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. A common sports injury whichusually happens over time from normal wear and tear ofmuscles and tendons. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Discussion: Treatment of ACL mucoid degeneration by arthroscopic resection is effective for . -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. 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. anterior cruciate ligament mucoid degeneration; mucoid degeneration of the triangular . Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. The etiology of cruciate ligament ganglion cysts is uncertain. 2023 BioMed Central Ltd unless otherwise stated. Most surgeons recommend a program of physical therapy post-operatively to reduce pain and swelling, promote full range-of-motion, and improve knee function. 2014;42:1567. Ghanasingh Fine Jewels, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra, 400007, India, Galaxy Hospital, Kolar Road, Bhopal, Madhya Pradesh, 462042, India, Canadian Hospital, Abu Hail, Dubai, United Arab Emirates, You can also search for this author in Do you ever feel that your knee is unstable or unable to support your weight? A longer recovery period may reduce the risk of re-injury. At minimum 2years post-operatively, patients were called for a follow-up, and they were assessed clinically for ROM and stability by a blinded clinician not involved in the clinical care of the patients. The MR-findings of mucoid degeneration of the ACL include: an ill-defined ACL; an increased ligamentous girth To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The soft-tissue thickening and increased signal intensity along the course of the ligament with either form of cyst may be confused with the appearance of an ACL tear. Mucoid degeneration of the ACL is a rare cause of knee pain in the middle-aged patient group, without knee instability. The minimum follow-up was 3 years. 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. mucoid degeneration of acl mri. At arthroscopy, the ACL appeared homogenous, bulbous, and hypertrophied in all patients. Scribd adalah situs bacaan dan penerbitan sosial terbesar di dunia. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. A painful injury where the upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues. 1998-2023 Mayo Foundation for Medical Education and Research. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Rehabilitation, orthophony, crenotherapy. What is one assumption of Freud's psychoanalytic theory? 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. 2022 - 2023 Times Mojo - All Rights Reserved 3 Do-Dai DD, Youngberg RA, Lanchbury FD, et al: Intraligamentous ganglion cysts of the anterior cruciate ligament: MR findings with clinical and arthroscopic correlations. Connect with thousands of patients and caregivers for support and answers. [22], Pandey etal. 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. Follow us on social media for the latest updates, Future Medicine Ltd, Unitec House, 2 Albert Place, London, N3 1QB, UK, We use cookies to improve your experience. After collecting their demographic details, the ROM of the affected knee was noted, following which they were planned for surgery in the form of mobile-bearing UKA. All 5 patients under- went arthroscopic surgery. Follow the R.I.C.E. Interested in more discussions like this? maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid What is your diagnosis? California Privacy Statement, There have been only some reported cases of mucoid degeneration of the ACL in the English literature. Int J Curr Res Acad Rev 4(11):1824. interval progression at C5-6. [22]. If the address matches an existing account you will receive an email with instructions to reset your password. It can cause pain and to a meniscal tear. https://link.springer.com/10.1007/s00590-021-03198-4. Considering a dearth of studies that evaluates the effect of debulking an ACL with mucoid degeneration, more prospective studies with larger sample size and longer follow-up period are encouraged to corroborate the findings of this study. However, upon following-up with these patients, and gauging their clinical and functional parameters, complaints of rest pain and restriction of terminal flexion seemed to persist. All Rights Reserved. Indian J Orthop 46(5):561565. ACL Injury Grades. [email protected] +86 18163351462(WhatsApp) 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). If your activities do not involve making pivoting movements on the knee, physical therapy rehabilitation may be all you need. Accessed Nov. 13, 2018. Ventura etal. Mayo Clinic is a not-for-profit organization. Accessed Nov. 13, 2018. Enter your email address below and we will send you the reset instructions. The scores were then compiled and statistically analysed using SPSS-24 software to understand if the debulking resulted in any significant difference in the outcomes. Mucinous material within the substance of ACL produces pain and limited motion in the knee. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. J Orthop Traumatol. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. 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). Feb 17, 2023 7:27 AM. Purpo. These patients were included in group A (na=216). Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. 1st ed. A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. Physiotherapy and yoga based exercises will help you. 2). What is the meaning of mucoid degeneration? 18 Apr 2021. 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). Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. The anterior cruciate ligament (ACL) is an important ligament in the knee. Notchplasty is an ancillary surgical procedure that consists of reshaping and widening of the intercondylar femoral notch, historically developed and performed with the aim to avoid ACL graft impingement and improve visualization of the lateral wall of the femoral notch during ACLR surgery. Discrete intraosseous ganglia are observed in 3/4 of the cases with mucoid degeneration of the ACL. Papers of special note have been highlighted as: of interest. (5a) Cystic form of ACL ganglion cyst. Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. It is commonly associated with characteristic clinical findings such as progressive knee pain and discomfort on prolonged sitting or standing in a fixed posture, without history of a significant trauma or instability preceding the symptoms. . The severity of the ACL injury is graded from 1 to 3. The treatments all help with back and hip pain but I have a consistent back-of-knee pain that worsens with walking. cystic degeneration degeneration with formation of cysts. mucoid degeneration acl symptoms. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. (2a) T1-weighted sagittal image demonstrates an enlarged, club-shaped anterior cruciate ligament (arrows). Which Teeth Are Normally Considered Anodontia. Anterior cruciate ganglion cysts are probably more prevalent than stated in the literature. https://doi.org/10.1016/j.eats.2017.11.006, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligamentmanagement and functional outcome of 18 cases. A: ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. The purpose of this study was to diagnose mucoid degeneration of ACL and to assess the effectiveness of arthroscopic treatment in these patients. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. The time it takes to recover is approximately 3 months. Friends. 58th ed. As this improvement might not be entirely due to PRP, high-end comparative studies are needed to confirm its efficacy. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. The rest of the surgery remained the same and all patients underwent mobile-bearing Oxford UKA. The ligament can also tear due to work injuries or automobile accidents. Since the ACL is an extrasynovial structure, irritation or trauma to the synovium covering the ACL may initiate the release of hyaluronic acid and the production of mucin causing the development of a ganglion cyst within or adjacent to the cruciate ligament . The demographic distribution of study population with respect to the mean age, gender distribution and the side affected was similar to the recent studies done on the MD-ACL as a standalone entity [2, 3, 5, 8]. [7] have documented the presence of flexion contracture, we did not notice the same in any patient from the recruited sample size. On inter-group comparison, VAS score for rest pain of the debulking group (0.130.46) was also found to be lower than the non-debulking group (2.640.95) (p<0.05). https://doi.org/10.4103/0019-5413.128765, Article J Bone Jt Surg Ser B 81(2):304305. The most common cause of meniscus tears is age related degeneration. The appearance can mimic acute or chronic interstitial partial tears of the ACL. The median age of the affected population is estimated to be 51years [5]. Little is known about this condition that affects 1.85.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. Although a few studies such as the one by Lee etal. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Treatment: For symptomatic knees surgical debulking /debridement in which thickened part of the ACL is shaved off, is the treatment of choice. Culmination of these results meant that even the patient satisfaction at 2years follow-up was better in the debulking group. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but Remote ligamentous trauma as well as mucinous degeneration associated with aging likely play a role in the development of cruciate cysts. It results in postoperative laxity, but rarely in frank instability. Subsequently, controlled debulking of the posterolateral fibers was done using a 15-number blade until it was possible to tug at the ACL by passing a hook between the lateral femoral condyle and the posterolateral fibres of the ACL (Fig. Mucoid Degeneration of Posterior Cruciate Ligament Leads to Roof Impingement with Anterior Cruciate Ligament: Case Report.