2014;42:1567. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. M.P. It can be misdiagnosed a partial ACL tear. [5] and Chudasama etal. 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. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. However, all of these debridements were done under arthroscopy, whereas the surgeons in this study progressively debulked the ACL by open method using a 15-number blade, under direct vision. It included all patients who were diagnosed with mucoid degeneration of ACL and underwent mobile-bearing Oxford partial knee arthroplasty between January 2017 and February 2020, by consecutive sampling method. 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. Treatment: For symptomatic knees surgical debulking /debridement in which thickened part of the ACL is shaved . The appearance can mimic acute or chronic interstitial partial tears of the ACL. 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. Which Teeth Are Normally Considered Anodontia. 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. 4th ed. 58th ed. Patients were followed up post-surgery for rehabilitation. The stability measurements were subjective, and although undertaken by a blinded clinician, could be susceptible to human error. The median age of the affected population is estimated to be 51years [5]. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. This was confirmed at 2years follow-up, when the patients who underwent debulking showed a statistically significant improvement in in mean terminal flexion by 21.51 in group B (mean pre-operative: 96.3855.78; mean post-operative: 117.892.64) as compared with 5.02 in group A (mean pre-operative: 98.0934.79; mean post-operative: 103.114.1). (Table 2). 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). To summarize, debulking of mucoid ACL in patients undergoing unicompartmental knee arthroplasty significantly reduces the rest pain and improves the final range of motion of the knee joint, subsequently improving the overall functional and clinical outcome of the patient and resulting in greater patient satisfaction. Treatment Notes prior to January 29, 2019 . Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. By using this website, you agree to our 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. Truncation means that the . CAS Privacy CAS But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. The side of my knee is achy as well and I had a meniscus repair in 2012 and have had a few injections there as well. c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. . California Privacy Statement, A.R. Hence, we targeted a minimum sample size of 400 patients. anterior cruciate ligament mucoid degeneration; mucoid degeneration of the triangular . 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. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . 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. The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case series. 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. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. Health. 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. CAS 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. It is postulated that intraosseous extension may be a finding more often associated with pain (8a). By a paramedian incision and mini-midvastus arthrotomy, the joint was exposed. How common is mucoid degeneration of the ACL? On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. RADIOLOGIC FINDINGS: Left retrograde pyelogram was performed. The authors declare that they have no competing interests. These patients may complain of pain and stiffness, and large ganglia may cause limitation of extension. (3a) A proton density-weighted sagittal image at the same level demonstrates increased signal within the enlarged anterior cruciate ligament (arrows) with faintly identified ACL fibers. K Munde: Substantial contributions to the design of the work, analysis of the data for 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. Without adequate and timely treatment, . The Infona portal uses cookies, i.e. Close. I have multiple issues spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Advertising revenue supports our not-for-profit mission. Inclusion criteria was as follows: (1) clinicoradiological confirmation of MD-ACL and medial compartment osteoarthritis (MCOA) of the affected knee joint; (2) patients with less than 10 of varus or 5 of valgus deformity and (3) patients with no flexion contracture. 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 . Without a properly functioning ACL, the other structures of the knee experience greater strain, which causes further injuries to tissues in the knee. 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. Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. AskMayoExpert. All Rights Reserved. Mucoid degeneration of the anterior cruciate ligament (ACL) is a clinical condition observed primarily in middle-aged patients presenting with knee pain and limited range of motion in the absence of symptoms of instability or a significant history of trauma [].ACL mucoid degeneration causes knee pain less frequently than meniscal tears or chondral defects [17, 18] and has been rarely reported . 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. 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. . 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Acta Orthop Scand 63(5):497501. The patients clinical history and symptoms do not support an ACL injury. Follow the R.I.C.E. 21 yrs old Male asked about Mucoid degeneration of ACL, 2 doctors answered this and 92 people found it useful. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but Anterior cruciate ligament injury. Two characteristic MR appearances have been described for ganglion cysts of the ACL. Purpo. Questions just answered: mucoid degeneration of acl physiotherapy. 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. Sequential intra-operative pictures (left to right): a Surgeon unable to pass the arthroscopy hook between the medial cortex of lateral femoral condyle and lateral border of mucoid ACL. https://doi.org/10.2214/ajr.182.5.18212835, Article 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. Non-traumatic thickening of the ACL was associated with osteoarthritis and meniscal tears in almost all cases and showed increased signal intensity and ill-defined borders simulating acute ligamentous tears. Did you hear a loud pop or feel a "popping" sensation? . 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. strings of text saved by a browser on the user's device. Interested in more discussions like this? Despite integrity and status of cruciates being paramount in a UKA, no study has evaluated the effect of debulking MD-ACL in this procedure. 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. American Journal of Sports Medicine. Ellman MB, et al. Surgery is typically not needed. https://doi.org/10.1007/s00167-011-1433-0, Article 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. was responsible for physiotherapy, writing review, editing and project administration. This content does not have an Arabic version. Often the diagnosis can be made on the basis of the physical exam . Arthrosc Tech 7(5):e459e463. Manage cookies/Do not sell my data we use in the preference centre. https://doi.org/10.1302/0301-620X.81B2.0810304, Article During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. This allows the doctor to see the knee structures more clearly. How long does it take an ACL to heal without surgery? Score: 4.7/5 (45 votes) . 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). 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. There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). They are relatively uncommon, and their exact aetiopathogenesis is still not clear. The most common cysts in the knee region are popliteal also called Bakers cysts. Medical Definition of mucoid degeneration. It can cause pain and to a meniscal tear. After surgery patient is allowed to walk from the next day. Does your knee ever "lock" or feel blocked when you're trying to move it? The ACL graft (arrow) is abnormally lax and demonstrates abnormally increased signal intensity, likely secondary to degeneration from chronic mechanical stress. Mucoid degeneration of ACL. PubMed Central Indian J Orthop 46(5):561565. Provided by the Springer Nature SharedIt content-sharing initiative. 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. It is postulated that mucoid degeneration may be a predisposing factor to the formation of ACL ganglion cysts . Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p<0.05) as compared with their counterparts. Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. Exclusion criteria was as follows: (1) patients with a previous history of having undergone reconstruction, repair or debulking of the ACL in the ipsilateral knee; (2) patients with a history of any surgery in and around the ipsilateral or contralateral knee, or ipsilateral hip or ankle joints; (3) patients with inflammatory arthritis; (4) patients with musculoskeletal and learning disorders and (5) patients diagnosed with mucoid degeneration of the PCL radiologically. Your knee may become more and more unstable and may give out more often. During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon tissue similar to a ligament that connects muscle to bone. 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. . -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. Papadakis MA, et al., eds. If nothing is done, the ACL injury may turn into chronic ACL deficiency. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. J Sports Med Phys Fit 48(4):483487, CAS Sun H, Gill TJ. Google Scholar, Lee JW, Ahn JT, Gwak HG, Lee SH (2021) Clinical outcomes of arthroscopic notchplasty and partial resection for mucoid degeneration of the anterior cruciate ligament. Journal of the American Academy of Orthopaedic Surgeons. They were however, supplemented by other objective methods such as comparison of pre-operative, post-operative and follow-up status of lateral view of plain radiograph in standing position, to look for any posterior translation of the femur which would suggest instability. 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. Mayo Clinic, Rochester, Minn. Nov. 24, 2018. Before an appointment, be prepared to answer the following questions: Mayo Clinic does not endorse companies or products. Am J Sports Med 29(5):600613. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Correlation with operation methods in 200 knees. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. https://doi.org/10.4055/cios.2018.10.3.307. An ACL sprain is when the ACL is overstretched (but not torn). J Arthosc 6:322, 1990. I remember that Dr. Jain came out from his clinic to see my mother because my mother was not able walk a single step. 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. Little is known about this condition that affects 1.85.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. Knee 18(3):168171. Treatment is only required if there are otherwise unexplained symptoms. https://doi.org/10.4103/0019-5413.128765, Article Anterior cruciate ligament (ACL) injury.Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. Return to play following anterior cruciate ligament reconstruction. 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]. Part of 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. However, young patients . Modalities such as icing, joint mobilization, and massage can provide short-term pain relief and reduce swelling. -Evaluated and planned treatment protocol in accordance with physician. PubMed Freedom from war and natural disaster. ), or their login data. 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. What are the findings? In most cases, consideration of the clinical history, careful evaluation of the MR appearance, including the lack of ancillary findings of an ACL tear, and physical examination allow confident differentiation of a ganglion cyst from a cruciate ligament tear. Mucinous material within the substance of ACL produces pain and limited motion in the knee. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. volume34, Articlenumber:40 (2022) . Knee 27(5):13321342. These cysts have a variable MR appearance and are not always confined to the substance of the ligament. Ventura etal. Papers of special note have been highlighted as: of interest. Cookies policy. As this improvement might not be entirely due to PRP, high-end comparative studies are needed to confirm its efficacy. An ACL sprain is when the ACL is overstretched (but not torn). Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. https://doi.org/10.1016/j.knee.2010.05.003, Keyes GW, Carr AJ, Miller RK, Goodfellow JW (1992) The radiographic classification of medial gonarthrosis. Doctors and physical therapists will perform tests to gauge your knee's stability, strength, function and readiness to return to sports activities at various intervals during your rehabilitation. Intraosseous ganglion 6. 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.
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