Considering a dearth of studies that evaluates the effect of debulking an ACL with mucoid degeneration, more prospective studies with larger sample size and longer follow-up period are encouraged to corroborate the findings of this study. The follow-up period was similar to that of Cha etal. 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. 2014;42:1567. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. If the address matches an existing account you will receive an email with instructions to reset your password. Main symptoms are pain during terminal knee flexion (as in squatting) feeling of heaviness/tiredness in the knee. This association has not yet been proven. Amyn M. Rajani. M.P. 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. Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). ), or their login data. The anterior cruciate ligament (ACL) is an important ligament in the knee. American Journal of Sports Medicine. This study showed that the patients who underwent debulking had statistically superior knee function, lesser rest pain and greater satisfaction rates at 2years of follow-up compared with those in whom MD-ACL was not debulked. Discussion: Treatment of ACL mucoid degeneration by arthroscopic resection is effective for . Do Men Still Wear Button Holes At Weddings? Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Mucoid degeneration of the anterior cruciate ligament: can platelet-rich plasma combined with reductionplasty provide better results? Ganglion cysts are filled with gelatinous and viscous fluid in the neighbourhood of joints or tendon sheaths. Subsequently, the final sample included 442 patients who were followed-up for at least 2years after surgery (Fig. 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). 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. PubMed Pre-operative and follow-up lateral radiographs of the patients who underwent debulking were analysed by a blinded radiologist and no posterior translation of the femur was noted, thereby confirming no instability caused by the debulking (Fig. Community. b Immediate post-operative radiograph showing no posterior translation of femur compared with pre-operative radiograph. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Score: 4.7/5 (45 votes) . Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. The authors did not perform stress tests. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. Breast cancer is one of the most common cancers in women, with more than 2 million new diagnoses last year alone. Close. (Tr. I get PT and acupuncture, have had several epidural injections, and am trying hard to avoid osteoporosis meds (was on bisphosphonates for many years many years ago) as well as spinal fusion. Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. A proton density-weighted coronal view from the same patient as seen in (A) and (B) reveals intraosseous ganglia (arrows) communicating with the ACL ganglion cyst (short arrow). Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). Part of Stability of the joint is not compromised on controlled debulking. Justamom21. Clin Radiol. 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. [5]. 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. The demographic data of the study population is presented in Table 1. Your knee may become more and more unstable and may give out more often. These cysts have a variable MR appearance and are not always confined to the substance of the ligament. Sports medicine & outpatient orthopedics. interval progression at C5-6. They were however, supplemented by other objective methods such as comparison of pre-operative, post-operative and follow-up status of lateral view of plain radiograph in standing position, to look for any posterior translation of the femur which would suggest instability. They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. b Open debulking of mucoid ACL under direct vision using 15-number blade. The treatment alternatives, indications for the planned procedure and risks were discussed with her in detail and an informed consent was obtained. PubMed 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. These appearances must be differentiated from mucoid degeneration of the intact ACL. In: Current Medical Diagnosis & Treatment 2019. Enter your email address below and we will send you the reset instructions. Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. The most common cause of meniscus tears is age related degeneration. 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. Am J Roentgenol 182(5):12831287. 2001. We describe Arthroscopic near total debridement of mucoid degenerated ACL in . "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. Details on the top journals, universities, and authors on t. 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]. 373) A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion and pericruciate synovitis . On inter-group comparison, the group in which debulking was done had better mean KSS and mean IKDC score at 2years of follow-up (p<0.05). > Follow SCIRP. customer@scirp.org +86 18163351462(WhatsApp) Despite recent developments suggesting that debulking of MD-ACL does not cause instability [8], the involvement of another surgery that can directly be impacted by it complicates the decision making. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee. 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. 308 Ventura et al. Reactive marrow edema (arrowheads) surrounds the intraosseous ganglia. J Comput Assist Tomogr 1996 Jan-Feb; 20(1): 80-4. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. There's no set time frame for athletes to return to play. [21] and Ventura etal. After surgery you'll resume another course of rehabilitative therapy. Physiotherapy. Background: There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). Google Scholar, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. The abnormal sliding within the knee also can hurt cartilage. RADIOLOGIC FINDINGS: Left retrograde pyelogram was performed. Methodology: Five patients who were diagnosed as a case . Sigmund Freud emphasized the importance of the unconscious mind, and a primary assumption of Freudian theory is that the unconscious mind governs behavior to a greater degree than people suspect.Indeed, the goal of psychoanalysis is to make the unconscious conscious. Acta Orthop Scand 63(5):497501. Do any specific movements seem to improve or worsen your symptoms? Reeducation. 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. I have multiple issues spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Answered . 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. Do you ever feel that your knee is unstable or unable to support your weight? 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. By using this website, you agree to our 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. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Papadakis MA, et al., eds. Clin Orthop Relat Res 248:1314, Hotchen AJ, Melton JTK (2018) Radiofrequency ablation for mucoid degeneration of the anterior cruciate ligament. CAS During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. Sagittal T1-weighted (1a) and fat-suppressed proton density-weighted (1b) images are provided. Sequential intra-operative pictures (left to right): a Surgeon unable to pass the arthroscopy hook between the medial cortex of lateral femoral condyle and lateral border of mucoid ACL. Injury prevention. model of self-care at home: Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. Treatment Notes prior to January 29, 2019 . 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. Did you hear a loud pop or feel a "popping" sensation? 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. Very minor tears (sprains) may heal with non-surgical treatments and regenerative medicine therapy. just over two decades ago [1], the interest in this condition has quickly gathered pace in the orthopaedic community. Lippincott-Raven; 1997. A surgical procedure that involves replacing a damaged, worn or diseased knee with an artificial joint to restore knees movement. Connect with thousands of patients and caregivers for support, practical information, and answers. 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]. [5] and Chudasama etal. During arthroscopic ACL reconstruction, the surgeon makes several small incisionsusually two or threearound the knee. These patients who underwent UKA with debulking of MD-ACL were included in group B (nb=226). mucoid degeneration acl symptoms. Such meniscal tears are not appropriate for repair most of the time (Fig. It can be secondary to trauma, or simply degeneration caused by meniscal injury, osteoarthritis or chondral damage [2]. I have multiple issues - spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. PubMed Central 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. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. Various techniques have been proposed for the debulking of MD-ACL including arthroscopic debridement using shaver or radiofrequency ablation, with or without notchplasty, that have shown to give good clinical results [8, 19]. Pristine condition of the lateral compartment and not more than grade II in the patellofemoral compartment (Ahlbck classification) was confirmed in all cases. Int J Curr Res Acad Rev 4(11):1824. A few studies have shown direct correlation between the presence of meniscus tear in patients with MD-ACL. 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. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. 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). They assessed the stability of the joint with the Lachman test intra-operatively, confirming it to be either grade zero or one, with firm end point, before commencing with the UKA [16]. 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. What is the meaning of mucoid degeneration? Physical therapy typically begins 7-10 days after the procedure. Mayo Clinic, Rochester, Minn. Nov. 24, 2018. Before an appointment, be prepared to answer the following questions: Mayo Clinic does not endorse companies or products. Diagnosis. Mucinous material within the substance of ACL produces pain and limited motion in the knee. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. J Orthop Traumatol. 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. Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, . On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. Others may make an appointment with their family doctors. Knee Surgery & Related Research 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. 4th ed. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. 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. The ACL can be injured or torn in a number of different ways. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. [6] and Lintz etal. 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 ). Papers of special note have been highlighted as: of interest. What happens if a torn ACL goes untreated? What is one assumption of Freud's psychoanalytic theory? During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. strings of text saved by a browser on the user's device. This denoted adequate release of the impinging fibers against the lateral femoral condyle, femoral notch and PCL. By a paramedian incision and mini-midvastus arthrotomy, the joint was exposed. 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. The most common cysts in the knee region are popliteal also called Bakers cysts. 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. The results found improved functional scores and pain scores compared with preoperative levels. 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 . 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. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. Springer Nature. In patients undergoing UKA and diagnosed with mucoid degeneration of the ACL, controlled debulking of the ACL provides better functional outcomes as compared with non-debulking of the mucoid ACL. . 5 Stoller DW: Magnetic Resonance Imaging in Orthopaedics and Sports Medicine . The excised ACL tissue was sent for histopathological confirmation of mucoid degeneration. Paterno MV, et al. Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. They are relatively uncommon, and their exact aetiopathogenesis is still not clear. It can trap and damage the menisci in the knee and can also lead to early osteoarthritis. Is this likely to cause my knee pain or can it be the compressed lumbar nerve or both? This is a 79-year old woman with recently found asymptomatic left hydronephrosis. 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). Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. 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. 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. Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament Clinics in Orthopedic Surgery Vol. Instrumental treatment. Often the diagnosis can be made on the basis of the physical exam . https://doi.org/10.1302/0301-620X.81B2.0810304, Article 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 . https://doi.org/10.1007/s00167-011-1433-0, Article 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 end point was ascertained to be when the surgeon could pass a hook between the medial cortex of the lateral femoral condyle and the lateral border of the remaining ACL. (8a) Intraosseous extension of an ACL ganglion. Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. 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. 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. Knee 18(3):168171. 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. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. The appearance can mimic acute or chronic interstitial partial tears of the ACL. was the primary surgeon and was responsible for the conceptualization, methodology, supervision, writing review and editing. 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. 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. . Flag this answer. The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case series. 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]. -Evaluated and planned treatment protocol in accordance with physician. 3). We believe that meniscal mucoid degeneration with tear is not uncommon. 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.