mucoid degeneration of acl physiotherapy

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Disclaimer. Orthop Traumatol Surg Res. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Arthroscopy. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. [6], in 62% of patients (18 of 29) in the study of Lintz et al. Coronal proton density-weighted magnetic resonance, Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate, Sagittal proton density-weighted magnetic resonance, Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased, Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate, Pre-debridement arthroscopic view showing yellowish. 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. See this image and copyright information in PMC. 2. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. J Knee Surg. No reconstruction was performed at the same time. Hide glossary Glossary. 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). what causes mucoid degeneration of acl. 2021 Oct 21;2021:5879121. doi: 10.1155/2021/5879121. Discussion: and transmitted securely. https://doi.org/10.1186/s43019-021-00110-6, DOI: https://doi.org/10.1186/s43019-021-00110-6. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. NCI CPTC Antibody Characterization Program. Careers. Roberts CC, Towers JD, Spangehl MJ et-al. Generally, we know little about this condition. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. 2008;24(6):642649. Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. Online ahead of print. bling. report that one patient had ACL reconstruction simultaneously after the ACL debridement. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. Orthop Traumatol Surg Res 96(4):400406, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2006;69(9):44952. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. Conditions that resembles the clinical findings are: Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Risk factors Predisposing factors include the following 1: aging Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Introduction: This site needs JavaScript to work properly. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. 1). Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782. Along with that, it also controls the internal rotation. It results in postoperative laxity, but rarely in frank instability. California Privacy Statement, ADVERTISEMENT: Supporters see fewer/no ads. Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate ligament ganglion cyst arising from superior aspect of ligament. Anterior knee pain is the more common complaint. All nine studies included patients with symptomatic MDACL confirmed by MRI (Table3). 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. . 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. (10%) and highest in the study of Ventura et al. Level of Evidence: Level IV. in 1999 [ 1 ]. Method. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. On MRI, the ligament is thickened and ill-defined with a "celery stalk" appearance. Arthroscopic debridement of the ACL resulted in good pain relief and improved range of movement in all studies, with postoperative improvement in the knee scores. Federal government websites often end in .gov or .mil. Arthroscopy 24(6):642649. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. The https:// ensures that you are connecting to the Download Citation | On Feb 1, 2023, O.R. The authors declare that they have no competing interests. Open Grey database was searched for grey literature using the same keywords. Disclaimer. Instrumental treatment. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. : A Meta-Analysis. Disclaimer. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Conclusions. (A) Bulging of, Fig. The primary intervention was arthroscopic ACL debridement in eight studies; this was combined with notchplasty in cases of impingement with the lateral wall of the notch in five studies [6, 14, 16,17,18] (Table 3). MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. Epub 2008 Apr 18. volume33, Articlenumber:26 (2021) Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Mucoid degeneration of the anterior cruciate ligament. An official website of the United States government. Accessibility Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). This may support the theory that it is a degenerative process. Indian J Orthop 46(5):561565. Arthroscopy 20(2):141146. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Therefore, indications for ACL resection must be carefully selected. Only nine studies met our inclusion criteria and they were all case series. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . Fig. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Loss to follow up was not mentioned in the other five studies [3, 6, 15, 17, 19]. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. On clinical examination, the active range of motion showed a flexion deficit. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Cho SD, Youm YS, Lee CC et-al. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. The aetiology of MDACL is not clearly understood. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. eCollection 2022 May-Jun. Anterior cruciate ligament mucoid degeneration. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). 1173185. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Before The clinical presentation is one of posterior pain with limited flexion. Results: https://doi.org/10.1302/0301-620X.81B2.0810304, Article The mean MINORS score was 9.5 out of 16 (412). Bergin et al. Morice et al. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first described in the literature in 1999.1 Since then, MD-ACL has been recognized as a pathology present on between 0.7% and 5.3% of magnetic resonance images performed for knee pain.2 MD-ACL is thought to be part of a spectrum of ACL disease that can range from ganglion cysts to MD.3 MD-ACL can either be primary (idiopathic . Unauthorized use of these marks is strictly prohibited. The purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported. Level of evidence: 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. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Mucoid degeneration of the anterior cruciate ligament: a case report. It has recently been postulated that mucoid degeneration of the ACL is related to the medial knee compartment joint space loss in patients with osteoarthritis or in the OA risk group 6. It is a chronic degenerative change of a bulky ACL that may lead to notch . However, MDACL is asymptomatic in most patients. Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint and if this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. Disclaimer. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. Knee Surg Sports Traumatol Arthrosc. Unable to load your collection due to an error, Unable to load your delegates due to an error. W B Saunders Co. (2005) ISBN:0721602703. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. (Table 3). Bethesda, MD 20894, Web Policies MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. Answer (1 of 2): Most of the time mucoid degenrative changes in the ACL does not cause any problemonly if u have sign of ACL instability or the bending of the knee is reduced you may need a arthroscopic evaluation usually u may skip without ACL reconstruction but some of us will need AcL recons. AJR Am J Roentgenol. Arthroscopy. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. Epub 2011 Feb 18. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Accessibility official website and that any information you provide is encrypted Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Seventeen females (67%) and eight males (33%) were included in the final analysis. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. A long duration of non-specific knee pain in a patient should be evaluated with MRI. Springer Nature. Chudasama et al. In six of the nine studies [6, 14, 16,17,18], arthroscopic debridement of the ACL was associated with simultaneous partial meniscectomy; this ranged from 13% in the study of Morice et al. ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and association with other intra-articular knee structural damage are still poorly understood. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 2007;245 (3): 916-7. 2004;182(5):12831287. government site. Postoperative clinical laxity was common, however, symptomatic instability was not. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. This ranged from 90 to 95% in all studies, except in the report by Kim et al., where only 53.8% of patients (57/106) had complete pain relief after surgery. official website and that any information you provide is encrypted Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Patients will . 2011 Mar;25(3):262-5. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine Its signal is increased on all sequences. Physical therapy typically begins 7-10 days after the procedure. https://doi.org/10.1016/j.jclinepi.2009.06.005. The site is secure. . A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion . Khanna et al. In the nine included studies, four different scores were used for outcome assessment. Mucoid degeneration itself is described as a yellow or brown substance which can be either seen through the most anterior fibers of the ACL or found by probing between them [ 19, 35] (Fig. Int J Curr Res Aca Rev 4(11):1824 http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI (2008) Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Conclusion: Ligaments are very tough, fibrous tissue structures. Keywords used for the Search were mucoid degeneration, anterior cruciate ligament and ACL. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. None of the studies was a randomised controlled trial and none had a control group. The site is secure. 2023 BioMed Central Ltd unless otherwise stated. Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but . Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. had the largest number of patients (91) with a mean age of 61 years, which was the oldest study population amongst the nine studies [16]. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Would you like email updates of new search results? Read More Created for people with ongoing healthcare needs but benefits everyone. Indian J Orthop 48(2):197202. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Chudasama CH, Chudasama VC, Prabhakar MM. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Please enable it to take advantage of the complete set of features! . This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. Please enable it to take advantage of the complete set of features! The extracted data were heterogeneous in terms of outcome assessment. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. Loganathan D, Soma Sundar S, Sundar S, Sahanand S, Rajan DV. Bookshelf The cause is not really known, but patients usually do not complain of instability. (48.2% (14/29 patients) with symptomatic instability), which may be due to the large number of patients with total resection of the ACL (58.6% (17 out of 29 patients)) (Table 4). All rights reserved. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-3615, Case 11: with Hoffa fat pad ganglion cyst, Case 12: tibial nerve schwannoma and ACL mucoid degeneration, Case 1: Complete ACL tear and meniscal tears, Case 2: Anomalous insertion of the medial meniscus, View Frank Gaillard's current disclosures, see full revision history and disclosures, anterior cruciate ligament ganglion cysts, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Mucoid degeneration of the anterior cruciate ligament, congenital or acquired synovial tissue entrapment between ACL fibers. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Therefore, indications for ACL resection must be carefully selected. MeSH Papadopoulou P. The celery stalk sign. Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. However, symptomatic instability was not common. This study was registered on PROSPERO [10], an international prospective register of systematic reviews (CRD42018087782). Methods: The minimum follow-up was 3 years. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. Mucoid degeneration of the anterior cruciate ligament. Conclusions: Careers. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Mucoid cystic degeneration of the cruciate ligament. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Individuals with mucoid degeneration of the ACL were excluded. A total of 313 knees in 292 patients were included in the nine studies. Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee Glossary of terms for musculoskeletal radiology. Each study was scored 02 on each question, with a global ideal score of 16. Arthroscopy. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Epub 2010 May 8. Clinical outcome was reported using a variety of scores (the Lysholm and International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the visual analogue scale (VAS) score) in the different studies; these are summarized in Table 4. Besides, the patient may also have trouble in moving. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. They respond well to a judicious arthroscopic release of the ACL with notchplasty. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. J Chin Med Assoc. Second, methodological quality assessment showed that three studies had low methodological quality. Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. Mucoid degeneration of the ACL is suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences in MRI is identified in a patient with physically intact ligament and no obvious trauma history. [18] did not comment on an association between MDACL and chondral or meniscal lesions: after the exclusion of that report, the total number of patients with associated chondral lesions was 226 out of 275 patients (82%) and 190 patients had meniscal lesions (69%). Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. CAS Characteristic: "celery stalk" appearance. The site is secure. J Bone Joint Surg Br. National Library of Medicine Categories were determined in accordance with the study of Ekhtiari et al. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Methodological quality of the studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria [11] (Table1). The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments.

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