Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Terms and Conditions, 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 ). government site. https://doi.org/10.1016/j.jclinepi.2009.06.005. In most cases Physiopedia articles are a secondary source and so should not be used as references. 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. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. (Table 3). Intact fibers are best seen on T2WI. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. Knee Surg Sports Traumatol Arthrosc. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Am J Roentgenol 182(5):12831287. A long duration of non-specific knee pain in a patient should be evaluated with MRI. IV (retrospective cohort study). Unauthorized use of these marks is strictly prohibited. Online ahead of print. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 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. Arch Orthop Trauma Surg. A total of nine studies were eligible for review. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.817.97 years (42-74 years). There was strong association with chondral lesions and meniscal tears. . 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). Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. 8600 Rockville Pike Arthroscopy. -, Hodler J, Haghighi P, Trudell D, Resnick D. The cruciate ligaments of the knee: Correlation between MR appearance and gross and histologic findings in cadaveric specimens. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. It results in postoperative laxity, but rarely in frank instability. See this image and copyright information in PMC. . Conclusions: Its prevalence in magnetic resonance imaging (MRI) is 1.8 to 5.3%, but not all lesions are symptomatic. https://doi.org/10.1016/j.arthro.2003.11.030, Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. National Library of Medicine Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Arthroscopy. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. Therefore, indications for ACL resection must be carefully selected. 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 (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. 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). Before 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 . FOIA Methods: Physiotherapy. This appearance can mimic acute or chronic interstitial partial tears of the ligament. official website and that any information you provide is encrypted Cite this article. Orthop Traumatol Surg Res. Introduction: 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. 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.). Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . Epub 2011 Feb 18. Patients and methods: 2006;69(9):44952. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. had the largest number of patients (91) with a mean age of 61 years, which was the oldest study population amongst the nine studies [16]. That is usually the journal article where the information was first stated. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Epub 2018 Jun 13. The origin of MDACL may be degenerative or traumatic. Method. J Clin Epidemiol 62(10):10061012. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Hide glossary Glossary. Federal government websites often end in .gov or .mil. Read More Created for people with ongoing healthcare needs but benefits everyone. 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 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). Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. 2001;30(6):312315. In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. 2008;24(6):642649. . The pathogenesis remains controversial. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. Introduction: 3. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Symptoms included limited range of motion (ROM) and posterior knee pain. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Knee Surgery, Sports Traumatology, Arthroscopy. No treatment is usually required. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . CAS Questions just answered: mucoid degeneration of acl physiotherapy. 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. MeSH -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. 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. The cause is not really known, but patients usually do not complain of instability. 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]. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. The author(s) read and approved the final manuscript. 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. Orthopedics; anterior cruciate ligament; arthoscopy. 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. . A total of 313 knees in 292 patients were included in the nine studies. Mucoid degeneration of the anterior cruciate ligament. 4. Fig. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Bergin et al. What you feel (symptoms) You feel heaviness in knee joint. Accessibility sharing sensitive information, make sure youre on a federal Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Google Scholar, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P (2010) Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. The ligament is mainly responsible for restraining anterior translation of knee. Before Unable to load your collection due to an error, Unable to load your delegates due to an error. The site is secure. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. 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. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). You can read more if you want. Bergin D, Morrison WB, Carrino JA et-al. 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. All nine studies included patients with symptomatic MDACL confirmed by MRI (Table3). Characteristic: "celery stalk" appearance. mucoid degeneration of acl mri. HHS Vulnerability Disclosure, Help Management of mucoid degeneration of the anterior cruciate ligament: a systematic . 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. 2023 BioMed Central Ltd unless otherwise stated. 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. Discussion: Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Its signal is increased on all sequences. Any discrepancy was resolved by the senior author. Pain was posterior in 23 knees (80%). Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Arthroscopic findings. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Arthroscopic findings. -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). (A) Bulging of, Fig. International Journal of Orthopaedics. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. We report a case of a patient with mucoid degeneration of the ACL, presenting with posterior knee pain and no history of a major knee trauma. Categories were determined in accordance with the study of Ekhtiari et al. Fourteen knees (48%) had limited flexion, on average 97 degrees. Open Grey database was searched for grey literature using the same keywords. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Reeducation. 2011 Jun;25(6):650-2. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. 2011;19(3):408411. Anterior knee pain is the more common complaint. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. 2011. Therefore, indications for ACL resection must be carefully selected. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Conclusions: Mucoid degeneration of the ACL is a clinical condition afflicting active middle-aged people without a single significant traumatic episode with a specific MRI picture. Unable to load your collection due to an error, Unable to load your delegates due to an error. Part of The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Two patients uderwent secondary ligamentoplasty. Orthop Traumatol Surg Res 96(4):400406, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. 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. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. Score: 4.7/5 (45 votes) . Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Four studies reported only postoperative scores, which were comparable to those in other studies. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Knee Surg Sports Traumatol Arthrosc. Bethesda, MD 20894, Web Policies Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Preoperative magnetic resonance imaging (MRI) scan. Knee. Bergin et al. 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. This was lowest in the study of Cha et al. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. official website and that any information you provide is encrypted Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. 2007;15 (1): 73-86. Epub 2018 Apr 21. -, Makino A, Pascual-Garrido C, Rolon A, Isola M, Muscolo DL. The extracted data were heterogeneous in terms of outcome assessment. Would you like email updates of new search results? 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. Careers. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Skelet Radiol 30(6):312315. Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. and transmitted securely. Arthroscopy. Learn how we can help 704 views Reviewed >2 years ago Thank MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. 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. Bookshelf Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Two reviewers independently screened the titles and abstracts of the retrieved records for eligibility. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate ligament. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Third, clinical outcomes were reported using a variety of scores, so a data meta-analysis was not possible. Privacy 2004;182(5):12837. National Library of Medicine 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. All rights reserved. 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). Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a well-recognized pathology characterized by the degradation of collagen fibers and infiltration of a mucoidlike substance, [1,2 . Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. TS designed the project, literature search and wrote the manuscript. Symptomatic ACL mucoid degeneration in middle-age athletes. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Epub 2008 Dec 17. 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.