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. Patient is advised to do exercises to get movement and strength again following surgery. The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. Anterior cruciate ligament (ACL) injuries. It can cause pain and to a meniscal tear. The results found improved functional scores and pain scores compared with preoperative levels. 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). Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Being a multicentric study involving five different surgeons, surgeon factors could potentially affect surgical procedure and clinical outcome, despite a predetermined endpoint for the debulking. Do you ever feel that your knee is unstable or unable to support your weight? It is characterised by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the substance of ACL leading to thickening of the native ACL and its impingement on the lateral femoral condyle, femoral notch and PCL, consequently causing knee pain and limited motion. Do any specific movements seem to improve or worsen your symptoms? It is a very rare cause of knee pain and can be diagnosed preoperatively on MRI. 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. This content does not have an Arabic version. 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. Finally, the patients who underwent debulking had a better mean subjective patient satisfaction (9.830.37 versus 8.680.71) at the final follow-up at 2years (p<0.05) (Table 2). 2023 BioMed Central Ltd unless otherwise stated. Ghanasingh Fine Jewels, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra, 400007, India, Galaxy Hospital, Kolar Road, Bhopal, Madhya Pradesh, 462042, India, Canadian Hospital, Abu Hail, Dubai, United Arab Emirates, You can also search for this author in When considering a UKA in such a patient, a plethora of dilemmas may arise in the mind of an orthopaedic surgeon vis a vis preserving the MD-ACL at the cost of functional limitation, or debulking it and predisposing the UKA to failure owing to instability. https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. c End-point of debulking when the surgeon can pass the arthroscopy hook between the medial cortex of lateral femoral condyle and lateral border of the native ACL effortlessly. J Clin Med 10(2):315. https://doi.org/10.3390/jcm10020315, Article J Orthop Traumatol. 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]. My knee pains while I sit on the floor or its difficult for me to stand or walk for a long time or I find its difficult to descend the stairs or my knee gets tired easily these days are the usual complaints. A painful injury where the upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues. Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. Results: Visual analogue scale and Lysholm scores improved compared with preoperative scores, along with strength (anterior drawer test and Lachman test). Some patient may also complain of pain with full knee extension. Main symptoms are pain during terminal knee flexion (as in squatting) feeling of heaviness/tiredness in the knee. A physical therapist will teach you exercises that you will perform either with continued supervision or at home. Love. Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. Methodology: Five patients who were diagnosed as a case . However, in some patients, ACL ganglion cysts cause significant clinical symptoms. ), or their login data. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. This content does not have an English version. Lippincott-Raven; 1997. ), or their login data. 373) A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion and pericruciate synovitis . It can cause pain and to a meniscal tear. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. The authors declare that they have no competing interests. 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. 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. Diagnosis is usually made on the MRI. What is your diagnosis? 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. Rehabilitation, orthophony, crenotherapy. Contact us. 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. 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. 5 Stoller DW: Magnetic Resonance Imaging in Orthopaedics and Sports Medicine . Knee 18(3):168171. 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. 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). This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. It is postulated that mucoid degeneration may be a predisposing factor to the formation of ACL ganglion cysts . [5] and Chudasama etal. S Banerjee: 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 are appropriately investigated and resolved. https://doi.org/10.1186/s43019-022-00169-9, DOI: https://doi.org/10.1186/s43019-022-00169-9. 2022 - 2023 Times Mojo - All Rights Reserved However, all of these debridements were done under arthroscopy, whereas the surgeons in this study progressively debulked the ACL by open method using a 15-number blade, under direct vision. Did you hear a loud pop or feel a "popping" sensation? Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). 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. If nothing is done, the ACL injury may turn into chronic ACL deficiency. New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Patients will . All 5 patients under- went arthroscopic surgery. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Subsequently, from January 2019, the surgeons started debulking the MD-ACL. Let others know if this answer was helpful PubMed Central What happens if you dont get surgery on a torn ACL? American Academy of Orthopaedic Surgeons. Rehabilitation, speech therapy, crenotherapy. DOI: 10.1016/J.JAJS.2015.12.001 Corpus ID: 74774556; Mucoid degeneration of the anterior cruciate ligament: Partial arthroscopic debridement and outcomes @article{Khanna2016MucoidDO, title={Mucoid degeneration of the anterior cruciate ligament: Partial arthroscopic debridement and outcomes}, author={Gagan Khanna and Rajan Sharma and Aditya Bhardwaj and Harjot S. Gurdutta and Deepak Agrawal and . 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Anterior cruciate ligament (ACL) injury.Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. This is a 79-year old woman with recently found asymptomatic left hydronephrosis. Your knee may become more and more unstable and may give out more often. Google Scholar, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. A few studies have shown direct correlation between the presence of meniscus tear in patients with MD-ACL. 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. Cookies policy. They cross each other to form an X with the anterior cruciate ligament in front and the posterior cruciate ligament in back. 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. https://www.uptodate.com/contents/search. ACL ganglion cyst occurs more frequently among relatively younger patients compared to mucoid degeneration. Close. I have persistent pain in the back of that knee that is exacerbated by walking and bending it. Get your query answered 24*7 only on | Practo Consult . However, young patients . . . Quadriceps and hamstring weakness are common features of people with symptomatic degenerative meniscal tears Surgery may address the structural injury, but 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. Do Men Still Wear Button Holes At Weddings? The cause is not really known, but patients usually do not complain of instability. Mucoid degeneration of the ACL is a very rare cause of knee pain. There's no set time frame for athletes to return to play. The authors did not perform stress tests. Breast cancer is one of the most common cancers in women, with more than 2 million new diagnoses last year alone. was responsible for physiotherapy, writing review, editing and project administration. The treatments all help with back and hip pain but I have a consistent back-of-knee pain that worsens with walking. The anterior cruciate ligament (ACL) is an important ligament in the knee. Am J . : tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. 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. Background: The anterior cruciate ligament (ACL) is the most commonly operated ligament of the knee. Subsequently, the final sample included 442 patients who were followed-up for at least 2years after surgery (Fig. 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. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 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. Indian J Orthop 46(5):561565. 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. (6a) "Celery stalk" form of ACL ganglion cyst. All Rights Reserved. Mucoid degeneration of anterior cruciate ligament (ACL). If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. J Bone Jt Surg Br 93(4):4768. Connect with thousands of patients and caregivers for support, practical information, and answers. Accessed Nov. 13, 2018. Often the diagnosis can be made on the basis of the physical exam . PubMed Central Anyone else have this and how was it treated if at all? M.P. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and MethodsBetween December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis . Anterior cruciate ganglion cysts are probably more prevalent than stated in the literature. Philadelphia, Pa.: Saunders Elsevier; 2015. https://www.clinicalkey.com. 3, 2018 www.ecios.org Mucoid degeneration (MD . Provided by the Springer Nature SharedIt content-sharing initiative. https://doi.org/10.4103/0019-5413.128765, Article Physiotherapy and yoga based exercises will help you. Pristine condition of the lateral compartment and not more than grade II in the patellofemoral compartment (Ahlbck classification) was confirmed in all cases. A pre-study power analysis was done for a minimum sample size of 400, using dependent and independent variables involved in the study outcome. 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. 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). Proton density-weighted sagittal demonstrates a diffusely increased size of the ACL with ill-defined increased signal and interspersed intact ACL fibers. Purpo. Interested in more discussions like this? 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. The MR-findings of mucoid degeneration of the ACL include: an ill-defined ACL; an increased ligamentous girth Voxel numbers of . Mucoid degeneration of the anterior cruciate ligament (ACL) is a clinical condition observed primarily in middle-aged patients presenting with knee pain and limited range of motion in the absence of symptoms of instability or a significant history of trauma [].ACL mucoid degeneration causes knee pain less frequently than meniscal tears or chondral defects [17, 18] and has been rarely reported . On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. 2014;42:1567. Knee Surg Sports Traumatol Arthrosc 21(3):658663. 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. Does your knee ever "lock" or feel blocked when you're trying to move it? 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. This study used PRP to augment the weakened ACL and followed patients for 1 year to assess outcomes. Anatomy. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Sun H, Gill TJ. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. The scores were then compiled and statistically analysed using SPSS-24 software to understand if the debulking resulted in any significant difference in the outcomes. You can read more if you want. Arthroscopic debridement may help relieve the anterior knee pain. Google Scholar, Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. b Open debulking of mucoid ACL under direct vision using 15-number blade. It also prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses [1]. Anterior knee pain is the more common complaint. Most surgeons recommend a program of physical therapy post-operatively to reduce pain and swelling, promote full range-of-motion, and improve knee function. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Knee Surg & Relat Res 34, 40 (2022). (Table 2). Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. Follow the R.I.C.E. 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. 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. This denoted adequate release of the impinging fibers against the lateral femoral condyle, femoral notch and PCL. The pain and disability associated with an ACL injury prompt many people to seek immediate medical attention. 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). 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 Posterior Cruciate Ligament Leads to Roof Impingement with Anterior Cruciate Ligament: Case Report. 4th ed. Friends. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee . Often these tears can occur with minimal load and trauma. c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. 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. Such meniscal tears are not appropriate for repair most of the time (Fig. 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. The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. Indian J Orthop 48(2):197202. [2]. 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. Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. . Background. An ACL sprain is when the ACL is overstretched (but not torn). How do you treat degenerative meniscus tear? 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. 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. It can be misdiagnosed a partial ACL tear. They offer less hospital stay and speedy recovery. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. Details on the top journals, universities, and authors on t. A single copy of these materials may be reprinted for noncommercial personal use only. The anterior cruciate ligament (ACL) is a key structure in the knee joint kinematics, as it resists anterior tibial translation and rotational loads. 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. Physiotherapy. What happens if a torn ACL goes untreated? The side of my knee is achy as well and I had a meniscus repair in 2012 and have had a few injections there as well. Among other conditions - osteoarthritis, osteopenia, spondylolisthesis- an MRI report showed "severe mucoid degeneration of the ACL" in my left knee. Clin Orthop Surg 10(3):307314. 2). It is postulated that intraosseous extension may be a finding more often associated with pain (8a). The ACL can be injured or torn in a number of different ways. Before an appointment, be prepared to answer the following questions: Mayo Clinic does not endorse companies or products. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears . Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. PubMed Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. The stability measurements were subjective, and although undertaken by a blinded clinician, could be susceptible to human error. model of self-care at home: Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. 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. Clin Radiol. 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. strings of text saved by a browser on the user's device. 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]. We describe Arthroscopic near total debridement of mucoid degenerated ACL in . A: ACL (anterior cruciate ligament) mucoid degeneration means the lesion of the ACL. These patients may complain of pain and stiffness, and large ganglia may cause limitation of extension. The patients clinical history and symptoms do not support an ACL injury. PubMed 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). 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 . ACL Reconstruction is a surgical procedure to reconstruct the ligament in the center of your knee in order torestore its function after an injury. CAS The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Part of All the patients were operated on in a leg hanging position and under tourniquet control. ACL Injury Grades. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. Reeducation. https://doi.org/10.1177/03635465010290051301, Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Scribd adalah situs bacaan dan penerbitan sosial terbesar di dunia. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. If your activities do not involve making pivoting movements on the knee, physical therapy rehabilitation may be all you need. what causes mucoid degeneration of acl. The follow-up period was similar to that of Cha etal. They are frequently seen at joints and tendons of the wrist but are rare in the region of knee joint. Informed written consent was obtained from all patients. As this improvement might not be entirely due to PRP, high-end comparative studies are needed to confirm its efficacy. The excised ACL tissue was sent for histopathological confirmation of mucoid degeneration. 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. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. It happens to everyone in the country from little girls to middle- Family. 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.
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