We believe that meniscal mucoid degeneration with tear is not uncommon. All the patients were operated on in a leg hanging position and under tourniquet control. ACL Injury Grades. (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. Get your query answered 24*7 only on | Practo Consult . What is mucoid degeneration of the meniscus? 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. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. In general, it takes as long as a year or more before athletes can safely return to play. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. 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. For such patients, decompression of the ganglion at arthroscopy or via CT guidance is indicated and provides prompt relief.3,5,6. A.R. 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. Little is known about this condition that affects 1.85.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. Instrumental treatment. As previously reported, typical symptoms of mucoid degeneration of the ACL include knee pain during deep flexion and painful limitation of motion. Background. 1). mucoid degeneration acl symptoms. Go to the Bones, Joints & Muscles Support Group. Knee Surg Relat Res 33(1):26. https://doi.org/10.1186/s43019-021-00110-6, Kennedy JA, Mohammad HR, Mellon SJ, Dodd CAF, Murray DW (2020) Age stratified, matched comparison of unicompartmental and total knee replacement. I have multiple issues spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. On exposure of the joint, ACL was looked for in terms of integrity and any degenerative changes. 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. 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. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2years follow-up. Accumulation of mucopolysaccharides at the meniscal interstitial area disrupts the collagen network and weakens the meniscus. Flowchart representation of selection process of sample size, intervention process and outcome assessment. ACL Injury Grades. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. All Rights Reserved. Anterior cruciate ligament injury. 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). A: ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. Treatment: For symptomatic knees surgical debulking /debridement in which thickened part of the ACL is shaved off, is the treatment of choice. (wikipedia.org)Rarely, intraosseous ganglion cysts occur, sometimes in . They cross each other to form an X with the anterior cruciate ligament in front and the posterior cruciate ligament in back. It happens to everyone in the country from little girls to middle- Family. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. 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. Accessed Nov. 13, 2018. By using this website, you agree to our Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Advertising revenue supports our not-for-profit mission. J Arthosc 6:322, 1990. 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. Does your knee ever "lock" or feel blocked when you're trying to move it? 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. 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. 2022 - 2023 Times Mojo - All Rights Reserved The severity of the ACL injury is graded from 1 to 3. 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]. The demographic data of the study population is presented in Table 1. 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. [5] and Chudasama etal. Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. This allows the doctor to see the knee structures more clearly. : tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. The ACL can be injured or torn in a number of different ways. Hence, we targeted a minimum sample size of 400 patients. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee. Subsequently, from January 2019, the surgeons started debulking the MD-ACL. Mumbai, Maharashtra, India. At arthroscopy, the ACL appeared homogenous, bulbous, and hypertrophied in all patients. Acta Orthop Scand 63(5):497501. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. T2-weighted sagittal view demonstrates localized fluid signal within the ACL (arrows). 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. Mayo Clinic, Rochester, Minn. Nov. 24, 2018. Informed written consent was obtained from all patients. PubMed Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. J Bone Jt Surg Br 73(4):582586. Sep 2017 - Feb 20186 months. statement and All 5 patients under- went arthroscopic surgery. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. It is postulated that mucoid degeneration may be a predisposing factor to the formation of ACL ganglion cysts . The left ureter was normal in the pelvis. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. https://doi.org/10.1016/j.knee.2020.06.004, Article Follow the R.I.C.E. Medical Definition of mucoid degeneration. 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. TimesMojo is a social question-and-answer website where you can get all the answers to your questions. Connect with thousands of patients and caregivers for support and answers. Anyone else have this and how was it treated if at all? Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. All rights reserved. Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. This content does not have an English version. They offer less hospital stay and speedy recovery. New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. 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. [4]showed high percentages of laxity post debulking of MD-ACL, a finding which would not allow a surgeon to carry out a UKA after the debulking. American Academy of Orthopaedic Surgeons. Others may make an appointment with their family doctors. Without adequate and timely treatment, . Indian J Orthop 48(2):197202. [22], Pandey etal. Cookies policy. Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. It is postulated that intraosseous extension may be a finding more often associated with pain (8a). Knee 27(5):13321342. Discrete intraosseous ganglia are observed in 3/4 of the cases with mucoid degeneration of the ACL. The ACL graft (arrow) is abnormally lax and demonstrates abnormally increased signal intensity, likely secondary to degeneration from chronic mechanical stress. The etiology of cruciate ligament ganglion cysts is uncertain. The anterior cruciate ligament (ACL) is a key structure in the knee joint kinematics, as it resists anterior tibial translation and rotational loads. Ganglion cysts are filled with gelatinous and viscous fluid in the neighbourhood of joints or tendon sheaths. 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. 2 Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM: Musculoskeletal MRI. These are found inside your knee joint. Physiotherapy and yoga based exercises will help you. Arthroscopic surgeries are key hole surgeries for joint disorders. The severity of the ACL injury is graded from 1 to 3. CAS Voxel numbers of . et al. Mucoid degeneration of the anterior cruciate ligament: can platelet-rich plasma combined with reductionplasty provide better results? 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. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. 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). Very minor tears (sprains) may heal with non-surgical treatments and regenerative medicine therapy. 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. Papadakis MA, et al., eds. 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. A steeper PTS angle, decreased notch width index, and transverse notch angle are significantly associated with the presence of mucoid degeneration of the anterior cruciate ligament in symptomatic MD-ACL patients. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee . Background: There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). 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]. The Infona portal uses cookies, i.e. What is your diagnosis? 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. [6] and Lintz etal. In: Current Medical Diagnosis & Treatment 2019. 1st ed. All authors contributed to the study conception and design. 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. On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. PubMed 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). AskMayoExpert. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. Most surgeons recommend a program of physical therapy post-operatively to reduce pain and swelling, promote full range-of-motion, and improve knee function. 308 Ventura et al. Results: Visual analogue scale and Lysholm scores improved compared with preoperative scores, along with strength (anterior drawer test and Lachman test).