https://doi.org/10.1302/0301-620X.73B4.2071640, Pandit H, Gulati A, Jenkins C (2011) Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. 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. customer@scirp.org +86 18163351462(WhatsApp) All Rights Reserved. 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. Acta Orthop Scand 63(5):497501. Discussion: Treatment of ACL mucoid degeneration by arthroscopic resection is effective for . Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study. A case of mucoid degeneration of the anterior cruciate ligament (ACL) is reported based on specific imaging features on MRI. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. 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. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. It can be misdiagnosed a partial ACL tear. 308 Ventura et al. Its function is to stabilize the knee while bending and rotating; the ACL also keeps the knee from shifting out of place or moving anteriorly (toward the front) with pivoting activities. Plain radiographs of all the patients taken in anteroposterior and lateral views (in standing) at 2years follow-up showed no signs of implant failure in any patient. 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. J Bone Jt Surg [Br] 68-B:608609, Kang SN, Smith TO, De Rover WBS, Walton NP (2011) Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. [21]. ACL Injury Grades. Although asymptomatic in most cases, MD-ACL has been associated with posterior knee pain and restriction of terminal flexion or extension, in addition to pain and discomfort after sitting for a prolonged period of time [4, 5]. Part of fatty degeneration deposit of fat globules in a tissue. 4th ed. 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. Treatment is only required if there are otherwise unexplained symptoms. c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Cite this article. M.P. 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. CAS PubMedGoogle Scholar. Physiotherapy. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. Do Men Still Wear Button Holes At Weddings? the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. Justamom21. Stability of the joint is not compromised on controlled debulking. 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. 2022 - 2023 Times Mojo - All Rights Reserved Clin Orthop Relat Res 248:1314, Hotchen AJ, Melton JTK (2018) Radiofrequency ablation for mucoid degeneration of the anterior cruciate ligament. During arthroscopic ACL reconstruction, the surgeon makes several small incisionsusually two or threearound the knee. Connect with thousands of patients and caregivers for support and answers. It also prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses [1]. CAS 5 Stoller DW: Magnetic Resonance Imaging in Orthopaedics and Sports Medicine . What is your diagnosis? 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. 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. https://doi.org/10.4103/0019-5413.128765, Article Accessed Nov. 13, 2018. 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. 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. The etiology of cruciate ligament ganglion cysts is uncertain. Terms and Conditions, This allows the doctor to see the knee structures more clearly. The cruciate ligaments control the back and forth motion of your knee. Let others know if this answer was helpful . American Journal of Sports Medicine. model of self-care at home: Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. The ortho I saw is a spine guy and said the knee didn't . 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. Knee 18(3):168171. A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, . 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 lesion may look like an elongated cyst along the long axis of the ACL, or as an enlarged ACL. 2). Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. 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). Anterior cruciate ligament (ACL) injuries. The severity of the ACL injury is graded from 1 to 3. Surgery is typically not needed. Anterior cruciate ligament injury. [5]. https://doi.org/10.1302/0301-620X.81B2.0810304, Article 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. Mucoid degeneration of anterior cruciate ligament (ACL) 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. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2years follow-up. . 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. This was a prospective, cohort, multicentric study conducted in five centres. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Ellman MB, et al. 373) A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion and pericruciate synovitis . (Tr. These patients were included in group A (na=216). Springer Nature. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. The Infona portal uses cookies, i.e. The minimum follow-up was 3 years. Histopathological confirmation of mucoid degeneration was obtained in all 442 patients. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. 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. K Kunal: 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. 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). Remote ligamentous trauma as well as mucinous degeneration associated with aging likely play a role in the development of cruciate cysts. 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]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 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. The ACL provides approximately 85% of the total restraining force of anterior translation. 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. Informed written consent was obtained from all patients. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. It can trap and damage the menisci in the knee and can also lead to early osteoarthritis. Intraosseous ganglion 6. Both the groups were matched in terms of age, body mass index, pre-operative ROM, pre-operative International Knee Documentation Committee (IKDC) score [17] and pre-operative Knee Society score (KSS) [18]. PubMed On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. 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. Friends. volume34, Articlenumber:40 (2022) on nine studies [8]. 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. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. 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. 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. 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 ). Indian J Orthop 48(2):197202. 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 . If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. Google Scholar, Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D (2011) Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. UKA by itself improves the functional and clinical outcome of patients with medial compartment osteoarthritis. 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. [2]. 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. The cause is not really known, but patients usually do not complain of instability. 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. Methodology: Five patients who were diagnosed as a case . The severity of the ACL injury is graded from 1 to 3. Anatomy. 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. Interested in more discussions like this? J Arthosc 6:322, 1990. Rehabilitation, orthophony, crenotherapy. It is postulated that intraosseous extension may be a finding more often associated with pain (8a). What happens if you dont get surgery on a torn ACL? During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. However, a predetermined list of criteria has been compiled over the years based on findings in published reports within which a patient needs to fall so as to be eligible to undergo a UKA. Am J Sports Med 29(5):600613. Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. How long does it take an ACL to heal without surgery? Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. (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. 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. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. 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.