J Bone Jt Surg Br 73(4):582586. 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. Method. 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. Feb 17, 2023 7:27 AM. The anterior cruciate ligament (ACL) is a key structure in the knee joint kinematics, as it resists anterior tibial translation and rotational loads. Pre-operatively, patients were examined and clinicoradiologically confirmed for MD-ACL and medial compartment osteoarthritis (MCOA) of the affected knee. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. 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. An anterior cruciate ligament (ACL) mucoid degeneration, along with tears and anterior cruciate ligament ganglion cysts, is a relatively common cause of incr. Therefore, indications for ACL resection must be carefully selected. Anyone else have this and how was it treated if at all? https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/. AskMayoExpert. All the patients were operated on in a leg hanging position and under tourniquet control. 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 acl mri. 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. Score: 4.7/5 (45 votes) . Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Subsequently, the final sample included 442 patients who were followed-up for at least 2years after surgery (Fig. The results found improved functional scores and pain scores compared with preoperative levels. These ganglia consist of myxoid material. A case of mucoid degeneration of the anterior cruciate ligament (ACL) is reported based on specific imaging features on MRI. 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. What happens if a torn ACL goes untreated? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 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. 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. 1998 Oct;53(10):771-3. strings of text saved by a browser on the user's device. PubMed Indian J Orthop 46(5):561565. All the demographic and biostatistical data was compiled and computed on the SPSS-24 software. The patients clinical history and symptoms do not support an ACL injury. All 5 patients under- went arthroscopic surgery. 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. Background: There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). https://doi.org/10.20546/ijcrar.2016.411.003, Chudasama CH, Chudasama VC, Prabhakar MM (2021) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. 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. 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). If the address matches an existing account you will receive an email with instructions to reset your password. 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. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar 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. After a database search of 4,221 knee MRI examinations, Bergin et al. Treatment: For symptomatic knees surgical debulking /debridement in which thickened part of the ACL is shaved . 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. Get your query answered 24*7 only on | Practo Consult . Google Scholar, White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. Freedom from war and natural disaster. The most common cause of meniscus tears is age related degeneration. It can be misdiagnosed a partial ACL tear. Knee Surgery & Related Research 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 . Instrumental treatment. Diagnosis. As this improvement might not be entirely due to PRP, high-end comparative studies are needed to confirm its efficacy. ACL Injury Grades. Intraosseous ganglion 6. Without adequate and timely treatment, . Reactive marrow edema (arrowheads) surrounds the intraosseous ganglia. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Histopathological confirmation of mucoid degeneration was obtained in all 442 patients. 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. TimesMojo is a social question-and-answer website where you can get all the answers to your questions. INTRODUCTION 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 . 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. Friedberg RP. The cause is not really known, but patients usually do not complain of instability. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. Among other conditions - osteoarthritis, osteopenia, spondylolisthesis- an MRI report showed "severe mucoid degeneration of the ACL" in my left 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. The excised ACL tissue was sent for histopathological confirmation of mucoid degeneration. c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. If nothing is done, the ACL injury may turn into chronic ACL deficiency. Close. Mucoid degeneration of the ACL is a very rare cause of knee pain. CAS (8a) Intraosseous extension of an ACL ganglion. [21] and Ventura etal. -Evaluated and planned treatment protocol in accordance with physician. Let others know if this answer was helpful On exposure of the joint, ACL was looked for in terms of integrity and any degenerative changes. Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. Another theory states that it is a consequence of herniation of a synovial pouch in the substance of the anterior cruciate ligament (ACL), and the subsequent synovial filling inside it; however, the major aetiology of MD-ACL still remains an enigma [4]. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Amyn M. Rajani. All authors contributed to the study conception and design. The authors presume that this objective end point suggests adequate debulking, just enough to remove the impingement factor from the lateral femoral condyle, femoral notch and PCL, and consequently the symptoms associated with the impingement. Sep 2017 - Feb 20186 months. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. https://doi.org/10.1007/s00167-011-1433-0, Article : tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. Anterior cruciate ligament ganglion cyst with intraosseous extension. https://doi.org/10.1016/j.knee.2020.06.004, Article Google Scholar, Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. 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. 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. This article belongs to the Special Issue on Radiation Therapy in the Treatment of Cancer < 1 2 3. The power of the study for the corrected model was estimated to be 92% for the aforementioned sample size when keeping the value of as 0.05, the degree of freedom (df) as 1, and adjusted R2 as 0.023. Remote ligamentous trauma as well as mucinous degeneration associated with aging likely play a role in the development of cruciate cysts. ), or their login data. This content does not have an English version. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee . This course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees. Very minor tears (sprains) may heal with non-surgical treatments and regenerative medicine therapy. The Infona portal uses cookies, i.e. However, young patients . Pristine condition of the lateral compartment and not more than grade II in the patellofemoral compartment (Ahlbck classification) was confirmed in all cases. 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. 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]. model of self-care at home: Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. (7a) Intra-articular extension of a cruciate ligament ganglion. Furthermore, the ancillary MR findings of an ACL tear, such as bone bruises and the MR anterior drawer sign, are absent. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study, https://doi.org/10.1186/s43019-022-00169-9, https://doi.org/10.1302/0301-620X.81B2.0810304, https://doi.org/10.2214/ajr.182.5.18212835, https://doi.org/10.1007/s00167-011-1433-0, https://doi.org/10.1007/s00167-012-1991-9, https://doi.org/10.1186/s43019-021-00110-6, https://doi.org/10.1016/j.knee.2020.06.004, https://doi.org/10.1302/0301-620X.73B4.2071640, https://doi.org/10.1016/j.knee.2010.05.003, https://doi.org/10.3109/17453679209154722, https://doi.org/10.1302/0301-620X.93B4.25562, https://doi.org/10.1186/s10195-020-00551-x, https://doi.org/10.1177/03635465010290051301, https://doi.org/10.1016/j.eats.2017.11.006, https://doi.org/10.20546/ijcrar.2016.411.003, https://doi.org/10.4055/cios.2018.10.3.307, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Lachmans test was performed intra-operatively in the immediate aftermath of the debulking, and only 27 (11.95%) knees were found to have grade one laxity with a firm end point, while no laxity was noted in the other knees. It may lead to knee pain. 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. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. 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. Besides, the patient may also have trouble in moving. 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). Signs and symptoms: It usually affects middle aged and elderly people. All rights reserved. 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 ). ACL Reconstruction is a surgical procedure to reconstruct the ligament in the center of your knee in order torestore its function after an injury. Background. https://doi.org/10.1007/s00167-012-1991-9, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. strings of text saved by a browser on the user's device. Knee 27(5):13321342. . 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. Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. [5]. During arthroscopic ACL reconstruction, the surgeon makes several small incisionsusually two or threearound the knee. An anteriorly protruding ganglion (arrow) arising from an ACL ganglion cyst (arrowheads) is well seen on a proton density-weighted sagittal image. Answered . [21]. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. 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. Subsequently, from January 2019, the surgeons started debulking the MD-ACL. It is a very rare cause of knee pain and can be diagnosed preoperatively on MRI. Two characteristic MR appearances have been described for ganglion cysts of the ACL. on nine studies [8]. They are relatively uncommon, and their exact aetiopathogenesis is still not clear. The pain and disability associated with an ACL injury prompt many people to seek immediate medical attention. Functional assessment was done by the same clinician using patient-related outcome measures (PROMs) using the self-questionnaire-based International Knee Documentation Committee (IKDC) score, Knee Society score (KSS), VAS score (for rest pain) and subjective satisfaction level. The severity of the ACL injury is graded from 1 to 3. just over two decades ago [1], the interest in this condition has quickly gathered pace in the orthopaedic community. The left ureter was normal in the pelvis. 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. 373) A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion and pericruciate synovitis . Have your symptoms been continuous or occasional? 2015;23:283. The median age of the affected population is estimated to be 51years [5]. 5 Stoller DW: Magnetic Resonance Imaging in Orthopaedics and Sports Medicine . The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. However, in some patients, ACL ganglion cysts cause significant clinical symptoms. The most common mechanism is that of a sudden pivoting or cutting maneuver during sporting activity, which is commonly seen in football, basketball and soccer. EMMY NOMINATIONS 2022: Outstanding Limited Or Anthology Series, EMMY NOMINATIONS 2022: Outstanding Lead Actress In A Comedy Series, EMMY NOMINATIONS 2022: Outstanding Supporting Actor In A Comedy Series, EMMY NOMINATIONS 2022: Outstanding Lead Actress In A Limited Or Anthology Series Or Movie, EMMY NOMINATIONS 2022: Outstanding Lead Actor In A Limited Or Anthology Series Or Movie. 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. These appearances must be differentiated from mucoid degeneration of the intact ACL. Patients will . 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). If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This replacement tissue is called a graft. https://doi.org/10.3109/17453679209154722, Gibson PH, Goodfellow JW (1986) Stress radiography in degenerative arthritis of the knee. Community. 58th ed. . He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. 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. Interested in more discussions like this? 3, 2018 www.ecios.org Mucoid degeneration (MD . 2). Modalities such as icing, joint mobilization, and massage can provide short-term pain relief and reduce swelling. 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. Provided by the Springer Nature SharedIt content-sharing initiative. DeLee JC, et al. . 2). I remember that Dr. Jain came out from his clinic to see my mother because my mother was not able walk a single step. Accessed Nov. 21, 2018. In this study, the authors hypothesised that debulking the MD-ACL with a predetermined, objective endpoint relieves the patient of the rest pain caused by the impingement and improves terminal flexion and functional outcome, without compromising the integrity and stability of the UKA. The etiology of cruciate ligament ganglion cysts is uncertain. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). It can trap and damage the menisci in the knee and can also lead to early osteoarthritis. All authors read and approved the final manuscript. The ACL graft (arrow) is abnormally lax and demonstrates abnormally increased signal intensity, likely secondary to degeneration from chronic mechanical stress. "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. 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). https://doi.org/10.4055/cios.2018.10.3.307. They cross each other to form an X with the anterior cruciate ligament in front and the posterior cruciate ligament in back. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. This was postulated to be due to the increased tension caused by the mucinous deposition in the substance of the ACL, leading to irritation of the native nociceptors of the tendon and the consequent impingement on the lateral femoral condyle, femoral notch and posterior cruciate ligament (PCL) owing to the increased thickness of the ACL [6,7,8]. What is your diagnosis? T2-weighted sagittal view demonstrates localized fluid signal within the ACL (arrows). 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. Predetermined inclusion and exclusion criteria were used for sample collection. Little is known about this condition that affects 1.85.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. If your activities do not involve making pivoting movements on the knee, physical therapy rehabilitation may be all you need. There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Mumbai, Maharashtra, India. 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. An interesting feature of cruciate ganglia, which has not been widely reported, is their tendency to extend into adjacent intra-articular spaces and osseous structures. It provides objective end points for open debulking of mucoid ACL in these patients and, being a multicentric study, it entails external validity of this procedure in a diverse population. How do you treat degenerative meniscus tear? Such meniscal tears are not appropriate for repair most of the time (Fig. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. The treatments all help with back and hip pain but I have a consistent back-of-knee pain that worsens with walking. Correspondence to Diagnosis is usually made on the MRI. Mucoid degeneration of anterior cruciate ligament (ACL). There's no set time frame for athletes to return to play. In patients undergoing UKA and diagnosed with mucoid degeneration of the ACL, controlled debulking of the ACL provides better functional outcomes as compared with non-debulking of the mucoid ACL. Sagittal T1-weighted (1a) and fat-suppressed proton density-weighted (1b) images. 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. https://doi.org/10.1302/0301-620X.81B2.0810304, Article J Clin Med 10(2):315. https://doi.org/10.3390/jcm10020315, Article Lippincott-Raven; 1997. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). . Informed written consent was obtained from all individual participants included in the study. Physical therapy typically begins 7-10 days after the procedure. 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). 21 yrs old Male asked about Mucoid degeneration of ACL, 2 doctors answered this and 92 people found it useful. American Academy of Orthopaedic Surgeons. Shelbourne Knee Center recommends activity modification and rest, medications, injections and/or physical therapy as the initial treatment(s). 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. The authors did not perform stress tests. No writing assistance was utilized in the production of this manuscript. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. Am J Roentgenol 182(5):12831287. The ACL can be injured or torn in a number of different ways. 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. Love. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament.