Did you hear a loud pop or feel a "popping" sensation? 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. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee . Such meniscal tears are not appropriate for repair most of the time (Fig. We offer latest arthroscopic and minimally invasive single and double row rotator cuff repair in cases of rotator cuff tear. Do you ever feel that your knee is unstable or unable to support your weight? California Privacy Statement, These findings were in line with the findings published by Cha etal. "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. . Journal of the American Academy of Orthopaedic Surgeons. 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 . Mucoid degeneration of the anterior cruciate ligament (ACL) is a common pathology but is often unknown and underdiagnosed. Methodology: Five patients who were diagnosed as a case . A.R. Recent research indicates that up to one-third of athletes sustain another tear in the same or opposite knee within two years. PubMedGoogle Scholar. ACL Injury Grades. As we age, the connections between the collagen fibers that make up the meniscus begin to deteriorate, causing failure of the structure and tears due to stresses in the joint. 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. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. Sagittal T1-weighted (1a) and fat-suppressed proton density-weighted (1b) images. I have multiple issues spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. : tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. Reeducation. On longitudinal, intra-group comparison of the individual groups, it was noted that there was statistically significant (p<0.05) improvement in the ROM of patients who underwent debulking (Z-value: 13.047; p-value: 0.00) as well as no debulking group (Z-value: 9.990; p-value: 0.00) at 2years follow-up, compared with their individual pre-operative ROM. This was a prospective, cohort, multicentric study conducted in five centres. Friends. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears . These patients were included in group A (na=216). A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, . Very minor tears (sprains) may heal with non-surgical treatments and regenerative medicine therapy. Often the diagnosis can be made on the basis of the physical exam . It's a site that collects all the most frequently asked questions and answers, so you don't have to spend hours on searching anywhere else. RADIOLOGIC FINDINGS: Left retrograde pyelogram was performed. statement and ACL Reconstruction is a surgical procedure to reconstruct the ligament in the center of your knee in order torestore its function after an injury. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. anterior cruciate ligament mucoid degeneration; mucoid degeneration of the triangular . . Sep 2017 - Feb 20186 months. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 4th ed. Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). The severity of the ACL injury is graded from 1 to 3. Flag this answer. Before an appointment, be prepared to answer the following questions: Mayo Clinic does not endorse companies or products. Answered . What is the meaning of mucoid degeneration? M.P. PubMed Anyone else have this and how was it treated if at all? An ACL injury is a tear or sprain of the anterior cruciate (KROO-she-ate) ligament (ACL) one of the strong bands of tissue that help connect your thigh bone (femur) to your shinbone (tibia).ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing such as soccer, basketball, football and downhill skiing. In general, it takes as long as a year or more before athletes can safely return to play. A few studies have shown direct correlation between the presence of meniscus tear in patients with MD-ACL. Depending on the severity of your injury, you may be referred to a doctor specializing in sports medicine or a specialist in bone and joint surgery (orthopedic surgeon). Furthermore, the ancillary MR findings of an ACL tear, such as bone bruises and the MR anterior drawer sign, are absent. Others may make an appointment with their family doctors. 2nd ed. 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. PubMed Central It can cause pain and to a meniscal tear. Accessed Nov. 13, 2018. The results found improved functional scores and pain scores compared with preoperative levels. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. https://doi.org/10.4103/0019-5413.128765, Article 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]. On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. Connect with thousands of patients and caregivers for support, practical information, and answers. https://doi.org/10.4055/cios.2018.10.3.307. Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. ACL ganglion cyst occurs more frequently among relatively younger patients compared to mucoid degeneration. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. This content does not have an Arabic version. Generally, we know little about this condition. The outcome analysis of both groups was done using the same follow-up protocol in terms of time (2years post-operatively), clinical tests (Lachmans test), functional scoring systems [IKDC score, KSS, rest pain by visual analogue scale (VAS)] and subjective patient satisfaction. Informed written consent was obtained from all patients. Community. 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. Treatment: For symptomatic knees surgical debulking /debridement in which thickened part of the ACL is shaved off, is the treatment of choice. There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. Am J Roentgenol 182(5):12831287. 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. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. 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 are the findings? An ACL sprain is when the ACL is overstretched (but not torn). 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]. 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. Do any specific movements seem to improve or worsen your symptoms? Advertising revenue supports our not-for-profit mission. Plain radiographs in lateral view (in standing) of the left knee of patient number 164 from group B (Left to Right): a Pre-operative radiograph for baseline position of posterior femur and tibia. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. However, the presence of MD-ACL means the associated impingement symptoms have the propensity to continue despite the arthroplasty. 1998 Oct;53(10):771-3. 58th ed. Since the ACL is an extrasynovial structure, irritation or trauma to the synovium covering the ACL may initiate the release of hyaluronic acid and the production of mucin causing the development of a ganglion cyst within or adjacent to the cruciate ligament . 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. J Clin Med 10(2):315. https://doi.org/10.3390/jcm10020315, Article It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Setback to comeback: Twin sisters return to the basketball court after ACL tears, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, NSF Certified for Sport Nutritional Supplements. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. 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. 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. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. In terms of treatment, doctors mostly recommend an arthroscopy, a minimally invasive surgical procedure which examines and sometimes . 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. Am J . 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. All rights reserved. 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. (Table 2). My MRI done in June states that I have very severe mucoid degeneration/partial thickness tearing of the ACL with the tibial spine tractional marrow edema. I know what the words mean. 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. Dietary management and various treatments Scanning and diagnostic . All the patients were operated on in a leg hanging position and under tourniquet control. What happens if a torn ACL goes untreated? 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. Health. Intraosseous ganglion 6. Provided by the Springer Nature SharedIt content-sharing initiative. 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. 21 yrs old Male asked about Mucoid degeneration of ACL, 2 doctors answered this and 92 people found it useful. Discrete intraosseous ganglia are observed in 3/4 of the cases with mucoid degeneration of the ACL. Subsequently, from January 2019, the surgeons started debulking the MD-ACL. Anterior cruciate ligament ganglion cyst with intraosseous extension. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. 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. Proton density-weighted sagittal demonstrates a diffusely increased size of the ACL with ill-defined increased signal and interspersed intact ACL fibers. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. 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. However, upon following-up with these patients, and gauging their clinical and functional parameters, complaints of rest pain and restriction of terminal flexion seemed to persist. Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity with disputed theories of origin [1,2,3,4]. All Rights Reserved. You can read more if you want. 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. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. To summarize, 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. b Open debulking of mucoid ACL under direct vision using 15-number blade. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar etal. On exposure of the joint, ACL was looked for in terms of integrity and any degenerative changes. Main symptoms are pain during terminal knee flexion (as in squatting) feeling of heaviness/tiredness in the knee. Patients will . 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]. Scribd adalah situs bacaan dan penerbitan sosial terbesar di dunia. https://doi.org/10.3109/17453679209154722, Gibson PH, Goodfellow JW (1986) Stress radiography in degenerative arthritis of the knee. There's no set time frame for athletes to return to play. Do Men Still Wear Button Holes At Weddings? (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. This study used PRP to augment the weakened ACL and followed patients for 1 year to assess outcomes. Clin Orthop Relat Res 248:1314, Hotchen AJ, Melton JTK (2018) Radiofrequency ablation for mucoid degeneration of the anterior cruciate ligament. Ganglion cysts are filled with gelatinous and viscous fluid in the neighbourhood of joints or tendon sheaths. The ACL can be injured or torn in a number of different ways. https://link.springer.com/10.1007/s00590-021-03198-4. 6 Antonacci VP, Foster T, Fenlon H, Harper K, Eustace S: Technical report: CT-guided aspiration of anterior cruciate ligament ganglion cysts. [6] and Lintz etal. How long does it take an ACL to heal without surgery? This association has not yet been proven. CAS 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. Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. These include pristine lateral and patellofemoral compartments, correctable varus deformity, less than 1015 of fixed flexion deformity, flexion of more than 100, and functionally intact collateral ligaments and cruciates [10,11,12,13,14,15]. Part of The authors did not perform stress tests. Let others know if this answer was helpful Accessed Nov. 13, 2018. 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]. . https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/. This replacement tissue is called a graft. Mucoid degeneration and ganglion cyst are two distinct non-traumatic lesions of the anterior cruciate ligament (ACL) that most commonly occur discretely but occasionally coexist. . strings of text saved by a browser on the user's device. https://doi.org/10.1177/03635465010290051301, Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. The demographic distribution of study population with respect to the mean age, gender distribution and the side affected was similar to the recent studies done on the MD-ACL as a standalone entity [2, 3, 5, 8]. https://doi.org/10.2214/ajr.182.5.18212835, Article 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. Skeletal Radiol 2001 Jun; 30(6): 312-5. A single copy of these materials may be reprinted for noncommercial personal use only. . Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. 1998-2023 Mayo Foundation for Medical Education and Research. Modalities such as icing, joint mobilization, and massage can provide short-term pain relief and reduce swelling. 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. . PubMed Central 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. After surgery patient is allowed to walk from the next day. Mucoid degeneration of the ACL is a rare cause of knee pain in the middle-aged patient group, without knee instability. (wikipedia.org)Rarely, intraosseous ganglion cysts occur, sometimes in . Mucoid degeneration of the ACL is a very rare cause of knee pain. 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. Methodology: Five patients who were diagnosed as a case of mucoid degeneration of the ACL based on MRI, over a period of 1 year (December 20182019), were included in the study. was the primary surgeon and was responsible for the conceptualization, methodology, supervision, writing review and editing.