Sep 2017 - Feb 20186 months. How do you treat degenerative meniscus tear? 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. Plain radiographs were taken in anteroposterior and lateral views at 2years follow-up for radiological analysis in the form of implant failure in all patients or anterior tibial translation in group B by a blinded radiologist. 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. 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. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. Mucoid degeneration of anterior cruciate ligament (ACL) Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. American Academy of Orthopaedic Surgeons. S Banerjee: Substantial contributions to the conception, drafting the work interpretation of data for the work, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Anterior cruciate ligament (ACL) injury.Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. Modalities such as icing, joint mobilization, and massage can provide short-term pain relief and reduce swelling. These patients who underwent UKA with debulking of MD-ACL were included in group B (nb=226). The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. . Score: 4.7/5 (45 votes) . However, the terminal ROM achieved after debulking MD-ACL was significantly better (p<0.05) at 2years of follow-up as compared with the group that did not undergo debulking. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. The minimum follow-up was 3 years. A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. The cruciate ligaments control the back and forth motion of your knee. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Additional Professor, Department of Orthopaedics, AIIMS Jodhpur, Jodhpur, Rajasthan, 342005, India, Senior Resident, Department of Orthopaedics, AIIMS Jodhpur, Jodhpur, Rajasthan, 342005, India. Connect with thousands of patients and caregivers for support and answers. All authors contributed to the study conception and design. This study used PRP to augment the weakened ACL and followed patients for 1 year to assess outcomes. (PDF) Mucoid Degeneration of the Anterior Cruciate Ligament : A Case Arthrosc Tech 7(5):e459e463. 2001. Diagnosis is usually made on the MRI. Anterior Cruciate Ligament, is an important structure of the knee joint. 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. anterior cruciate ligament mucoid degeneration; mucoid degeneration of the triangular . Unicompartmental knee arthroplasty (UKA) has rapidly emerged as a superior surgical option to total knee arthroplasty for bone-on-bone osteoarthritis owing to less trauma to the surrounding soft tissue, more conservative bone cuts, minimal bleeding, smaller incision, a better range of motion (ROM), faster recovery, preserved kinematics, higher rate of implant survival and decreased chances of major complications such as thromboembolism, cardiac arrest and stroke [9]. Methodology: Five patients who were diagnosed as a case of mucoid degeneration of the ACL based on MRI, over a period of 1 year (December 20182019), were included in the study. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. 58th ed. ACL Injury Grades. A painful injury where the upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues. The treatment alternatives, indications for the planned procedure and risks were discussed with her in detail and an informed consent was obtained. 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. . statement and Do Men Still Wear Button Holes At Weddings? what causes mucoid degeneration of acl. Instrumental treatment. It can cause pain and to a meniscal tear. The ortho I saw is a spine guy and said the knee didn't . It results in postoperative laxity, but rarely in frank instability. Laskowski ER (expert opinion). Am J Sports Med 29(5):600613. The purpose of this study was to diagnose mucoid degeneration of ACL and to assess the effectiveness of arthroscopic treatment in these patients. After surgery patient is allowed to walk from the next day. However, in some patients, ACL ganglion cysts cause significant clinical symptoms. Skeletal Radiol 2001 Jun; 30(6): 312-5. Hence, study objectives included determining the role and effects of debulking MD-ACL in a patient undergoing UKA as compared with those who do not undergo debulking, by clinical and functional analysis at 2years post-operatively. We believe that meniscal mucoid degeneration with tear is not uncommon. Close. It is postulated that intraosseous extension may be a finding more often associated with pain (8a). Hence, the improvement in ROM, attenuation of rest pain and better long term functional outcome measures supported the hypothesis regarding the positive effect of debulking a MD-ACL in patients undergoing UKA. Cureus | Anterior Cruciate Ligament Ganglion Cyst and Mucoid How common is mucoid degeneration of the ACL? . [7] have documented the presence of flexion contracture, we did not notice the same in any patient from the recruited sample size. Go to the Bones, Joints & Muscles Support Group. Treatment: For symptomatic knees surgical debulking /debridement in which thickened part of the ACL is shaved off, is the treatment of choice. 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. PubMed #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. . 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. In general, it takes as long as a year or more before athletes can safely return to play. However, young patients . But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. ACL Ganglion Cysts - Radsource Depending on the severity of your injury, you may be referred to a doctor specializing in sports medicine or a specialist in bone and joint surgery (orthopedic surgeon). Irish Journal of Medical Science (1971 -) Knee 18(3):168171. 1998 Oct;53(10):771-3. Deep Seated Pain at Back of Knee with Bending - Think of Mucoid What does mucoid degeneration of posterior horn of medial - HealthTap You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting, More than one ligament or the fibrous cartilage in your knee also is injured, The injury is causing your knee to buckle during everyday activities. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . RADIOLOGIC FINDINGS: Left retrograde pyelogram was performed. Which Teeth Are Normally Considered Anodontia. https://doi.org/10.1177/03635465010290051301, Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008 (5). Predetermined inclusion and exclusion criteria were used for sample collection. An ACL injury is a tear or sprain of the anterior cruciate (KROO-she-ate) ligament (ACL) one of the strong bands of tissue that help connect your thigh bone (femur) to your shinbone (tibia).ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing such as soccer, basketball, football and downhill skiing. Arthroscopic management of mucoid degeneration of anterior cru By a paramedian incision and mini-midvastus arthrotomy, the joint was exposed. Ellman MB, et al. https://doi.org/10.1016/j.knee.2020.06.004, Article The severity of the ACL injury is graded from 1 to 3. ACL Reconstruction is a surgical procedure to reconstruct the ligament in the center of your knee in order torestore its function after an injury. By continuing to browse this site, you accept our, International Journal of Endocrine Oncology, International Journal of Hematologic Oncology, Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C, Mucoid metaplastic-degeneration of anterior cruciate ligament, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR, Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation, Makino A, Pascual-Garrido C, Roln A, Isola M, Muscolo DL, Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK, Mucoid cystic degeneration of the cruciate ligament, Mucoid degeneration of the anterior cruciate ligament, Arthroscopic management of mucoid degeneration of anterior cruciate ligament, Pandey V, Suman C, Sharma S, Rao S, Kiran Acharya K, Sambaji C, Mucoid degeneration of the anterior cruciate ligament: management and outcome, Mucoid degeneration of the anterior cruciate ligament: a case report and review of literature, 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, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J, Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament, Kim T-H, Lee D-H, Lee S-H, Kim J-M, Kim C-W, Bin S-I, Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament, Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA, Platelet-rich plasma: from basic science to clinical applications, Southworth T, Naveen N, Tauro T, Leong N, Cole B, The use of platelet-rich plasma in symptomatic knee osteoarthritis, Vogrin M, Rupreht M, Crnjac A, Dinevski D, Krajnc Z, Renik G, The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study, Partial anterior cruciate ligament ruptures: advantages by intraligament autologous conditioned plasma injection and healing response technique midterm outcome evaluation, Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears, Rating systems in the evaluation of knee ligament injuries, Hensen JJ, Coerkamp EG, Bloem JL, Schepper AMD, Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P, Anterior cruciate ligament mucoid degeneration: selecting the best treatment option, Zicaro JP, Yacuzzi C, Garcia-Mansilla I, Costa-Paz M, Nonsurgical treatment of partial ACL tears: intraarticular injection of platelet-rich plasma did not change the progression rate to knee instability, Seijas R, Ares O, Cusc X, lvarez P, Steinbacher G, Cugat R, Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors, Long-term outcomes of primary repair of the anterior cruciate ligament combined with biologic healing augmentation to treat incomplete tears, McRobb J, Kamil KH, Ahmed I, Dhaif F, Metcalfe A, Influence of platelet-rich plasma (PRP) analogues on healing and clinical outcomes following anterior cruciate ligament (ACL) reconstructive surgery: a systematic review. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. 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. Anterior cruciate ligament injury. Community. b Immediate post-operative radiograph showing no posterior translation of femur compared with pre-operative radiograph. It also prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses [1]. ), or their login data. (4a) 3D rendering of an ACL ganglion viewed from the medial side with the medial femoral condyle removed. The rest of the surgery remained the same and all patients underwent mobile-bearing Oxford UKA. A total of 442 patients (na=216; nb=226) fulfilled the inclusion criteria and were followed up until a minimum of 2years post-surgery (mean: 252.46months; range: 2427.5months). The pain and disability associated with an ACL injury prompt many people to seek immediate medical attention. customer@scirp.org +86 18163351462(WhatsApp) If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This content does not have an Arabic version. 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. Corroborating these findings were the improvements and the final PROMs of both the groups which corresponded with the findings of the literature review by Sweed etal. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, The Anterior Meniscofemoral Ligament of the Medial Meniscus. You can read more if you want. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. A: ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. . 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. A case of mucoid degeneration of the anterior cruciate ligament (ACL) is reported based on specific imaging features on MRI. With debulking of MD-ACL being a relatively newer concept and insufficient data backing the eventual stability of the ACL, the surgeons primarily performed UKA without debulking in MD-ACL, until December 2018. Diffuse Intrasubstance Signal Abnormalities Ofthe Posterior Cruciate 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. Rajani, A.M., Shah, U.A., Mittal, A.R.S. strings of text saved by a browser on the user's device. https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/. On longitudinal, intra-group comparison of the individual groups, it was noted that there was statistically significant (p<0.05) improvement in the ROM of patients who underwent debulking (Z-value: 13.047; p-value: 0.00) as well as no debulking group (Z-value: 9.990; p-value: 0.00) at 2years follow-up, compared with their individual pre-operative ROM. 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. . 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. Autologous PRP, prepared by double spin protocol, was injected into the remaining ACL after partial debridement was done. 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. Google Scholar, Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. 308 Ventura et al. Anterior Cruciate Ligament (ACL) Rehabilitation - Physiopedia Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Cite this article. Do any specific movements seem to improve or worsen your symptoms? . Discussion: Treatment of ACL mucoid degeneration by arthroscopic resection is effective for . The excised ACL tissue was sent for histopathological confirmation of mucoid degeneration. Medical Definition of mucoid degeneration. Mucoid degeneration and ganglion cyst are two distinct non-traumatic lesions of the anterior cruciate ligament (ACL) that most commonly occur discretely but occasionally coexist. 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. 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. Indian J Orthop 46(5):561565. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. Subsequently, from January 2019, the surgeons started debulking the MD-ACL. All rights reserved. These are found inside your knee joint. It may lead to knee pain. A few studies have shown direct correlation between the presence of meniscus tear in patients with MD-ACL. Mucoid degeneration of the ACL is a very rare cause of knee pain. 2). Sagittal T1-weighted (1a) and fat-suppressed proton density-weighted (1b) images. 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. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Reactive marrow edema (arrowheads) surrounds the intraosseous ganglia. Mucoid degeneration of the anterior cruciate ligament: can platelet 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]. Manage cookies/Do not sell my data we use in the preference centre. A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, . While both the groups showed improvements in the functional scores post-surgery, which could be attributed to the UKA primarily, the finding that patients in whom debulking was done had better mean IKDC and mean KSS at 2years follow-up confirmed the study hypothesis that debulking improves the long-term outcome in patients with MD-ACL undergoing UKA. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. [5]. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. Without a properly functioning ACL, the other structures of the knee experience greater strain, which causes further injuries to tissues in the knee.