This study used PRP to augment the weakened ACL and followed patients for 1 year to assess outcomes. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. Intraosseous increased signal is present within the tibial spine deep to the posterior extent of the ACL insertion (arrowhead). 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Mucoid degeneration of the anterior cruciate ligament (ACL) is a common pathology but is often unknown and underdiagnosed. https://doi.org/10.1302/0301-620X.81B2.0810304, Article 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. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The follow-up period was similar to that of Cha etal. Instrumental treatment. This association has not yet been proven. 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. It can cause pain and to a meniscal tear. . 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. TimesMojo is a social question-and-answer website where you can get all the answers to your questions. Mucoid Degeneration of Posterior Cruciate Ligament Leads to Roof Impingement with Anterior Cruciate Ligament: Case Report. [2]. ACL Injury Grades. With an increasing trend of UKA being performed worldwide, the role of addressing concomitant MD-ACL is vital in improving the overall outcome of the patient without causing any instability or implant failure, as shown in this study. Main symptoms are pain during terminal knee flexion (as in squatting) feeling of heaviness/tiredness in the knee. [] 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. mucoid degeneration acl symptoms. Contact us. This denoted adequate release of the impinging fibers against the lateral femoral condyle, femoral notch and PCL. What is mucoid degeneration of the meniscus? [21]. As per study population statistics, the prevalence of medial meniscus tears (29.64%) in this study were congruent to the rates found in studies by Srivastava etal. These are found inside your knee joint. The samples collected from the five hospitals were 122 (group A: 58; group B: 64), 68 (group A: 35; group B: 33), 94 (group A: 46; group B: 48), 83 (group A: 41; group B: 42) and 75 (group A: 36; group B: 39), respectively. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears . Score: 4.7/5 (45 votes) . J Comput Assist Tomogr 1996 Jan-Feb; 20(1): 80-4. Your knee may become more and more unstable and may give out more often. 1st ed. The Infona portal uses cookies, i.e. 2 Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM: Musculoskeletal MRI. 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/. 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. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. The abnormal sliding within the knee also can hurt cartilage. A physical therapist will teach you exercises that you will perform either with continued supervision or at home. 2). 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. strings of text saved by a browser on the user's device. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Accessed Nov. 21, 2018. The pain and disability associated with an ACL injury prompt many people to seek immediate medical attention. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity with disputed theories of origin [1,2,3,4]. Correspondence to Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. -Evaluated and planned treatment protocol in accordance with physician. It's important to ensure that strength, stability and movement patterns are optimized before you return to an activity with a risk of ACL injury. 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. 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. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. We describe Arthroscopic near total debridement of mucoid degenerated ACL in . PubMed 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. This study holds clinical significance in terms of the very limited literature available on the role of MD-ACL in outcomes of patients undergoing UKA. All 5 patients under- went arthroscopic surgery. Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. All the demographic and biostatistical data was compiled and computed on the SPSS-24 software. 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 . It results in postoperative laxity, but rarely in frank instability. Predetermined inclusion and exclusion criteria were used for sample collection. Treatment Notes prior to January 29, 2019 . maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2years follow-up. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. The MR-findings of mucoid degeneration of the ACL include: an ill-defined ACL; an increased ligamentous girth 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. https://doi.org/10.2214/ajr.182.5.18212835, Article Being a multicentric study involving five different surgeons, surgeon factors could potentially affect surgical procedure and clinical outcome, despite a predetermined endpoint for the debulking. It can trap and damage the menisci in the knee and can also lead to early osteoarthritis. 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. J Bone Jt Surg Ser B 81(2):304305. CAS 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. After surgery you'll resume another course of rehabilitative therapy. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. . J Bone Jt Surg Br 73(4):582586. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. 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. 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. What is one assumption of Freud's psychoanalytic theory? Reactive marrow edema (arrowheads) surrounds the intraosseous ganglia. Int J Curr Res Acad Rev 4(11):1824. Results: Visual analogue scale and Lysholm scores improved compared with preoperative scores, along with strength (anterior drawer test and Lachman test). 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. 2022 - 2023 Times Mojo - All Rights Reserved It can be secondary to trauma, or simply degeneration caused by meniscal injury, osteoarthritis or chondral damage [2]. 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. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. Very minor tears (sprains) may heal with non-surgical treatments and regenerative medicine therapy. 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. 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. 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. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. What is the meaning of mucoid degeneration? Enter your email address below and we will send you the reset instructions. Histopathological confirmation of mucoid degeneration was obtained in all 442 patients. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. 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 . b Immediate post-operative radiograph showing no posterior translation of femur compared with pre-operative radiograph. anterior cruciate ligament mucoid degeneration; mucoid degeneration of the triangular . Manage cookies/Do not sell my data we use in the preference centre. We believe that meniscal mucoid degeneration with tear is not uncommon. Wilcoxon signed rank test was used for longitudinal intra-group comparison of ROM and PROMs between pre-operative and follow-up scores, whereas Mann Whitney U test was used to compare ROM and PROMs between the two groups at 2years follow-up. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. California Privacy Statement, Diagnosis is usually made on the MRI. Investigation, data curation, validation, writing original draft was done by U.S., A.M., S.G. and R.G. 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. Paterno MV, et al. The etiology of cruciate ligament ganglion cysts is uncertain. Return to play following anterior cruciate ligament reconstruction. Informed written consent was obtained from all patients. 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. Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. 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. Connect with thousands of patients and caregivers for support, practical information, and answers. Anterior cruciate ligament (ACL) injury.Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. CAS A.R. Surgery is typically not needed. There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. 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. The position of the femoral tunnel is important in graft isometry, permitting constant tension of the graft throughout the range of motion of the knee. 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. Clin Orthop Surg 10(3):307314. 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. This is a 79-year old woman with recently found asymptomatic left hydronephrosis. 2014;42:1567. Grade 1A laxity on Lachmans test (less than 5mm translation with a firm end-point) was noted in 27 knees (11.95%) intra-operatively in group B or those who underwent debulking (nb=226), whereas a firm endpoint with no translation was noted in all of the remaining 199 knees (88.05%).
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