mucoid degeneration of acl physiotherapy
Before The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. https://doi.org/10.4103/0019-5413.101037, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligament management and functional outcome of 18 cases. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Meniscectomy was undertaken in 11 cases (41%). Knee Surg Sports Traumatol Arthrosc 21(3):658663. Mucoid degeneration of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. The need for simultaneous or delayed ACL reconstruction should be discussed with patients in case total resection of the ACL is to be performed, particularly in young active patients. 2018;4(4):875-80. Please enable it to take advantage of the complete set of features! 2007;90(3):1923. Five studies demonstrated improved postoperative functional outcome scores compared to preoperative scores [6, 14, 16, 18, 19]. Tamer Sweed. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. Ventura et al. . https://doi.org/10.1016/j.arthro.2008.02.004, Morice A, Coupry A, Lintz F, Robert H (2013) Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. (100%). Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. 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. Post-debridement arthroscopic view showing yellowish, Post-debridement arthroscopic view showing yellowish lesion of the anterior cruciate ligament which was, MeSH On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. Symptomatic instability was highest in the study of Lintz et al. Careers. Level of evidence: Mumbai, Maharashtra, India. However, MDACL is asymptomatic in most patients. AJR Am J Roentgenol. official website and that any information you provide is encrypted Google Scholar, Chudasama CH, Chudasama VC, Prabhakar MM (2012) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Fig. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . The extracted data were assessed for meta-analysis. Any discrepancy was resolved by the senior author. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3% [4, 5]. 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Would you like email updates of new search results? 1 Its prevalence in magnetic resonance imaging (MRI) is 1.8-5.3%, but not all lesions are symptomatic.2, 3 It is characterized by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the National Library of Medicine An official website of the United States government. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Knee Surg Sports Traumatol Arthrosc. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine The pathogenesis remains controversial. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. 2006;69(9):44952. Preoperative and postoperative results of eleven patient were compared. J Clin Epidemiol 62(10):10061012. Physiotherapy. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. Hypothesis: Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Histological diagnosis was established by tissue biopsy in all patients in five studies, with a total of 87 knees. sharing sensitive information, make sure youre on a federal There was more than 20% loss to follow up in the study of Kim et al., while the three prospective studies had no loss to follow up [13, 14, 18]. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Federal government websites often end in .gov or .mil. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Patients and methods: All patients (100%, n=11) reported an improvement in pain. Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. (Table 3). Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Mucoid change or mucoid degeneration refers to the irreversible tissue degeneration due to the accumulation of mucin within the fibers of tendons, ligaments, and fibrocartilage. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Epub 2018 Aug 22. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon non-traumatic cause of knee pain and motion restriction, typically seen in a middle-aged population. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. Preoperative magnetic resonance imaging (MRI) scan. Chudasama et al. Conclusions 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 . Secondary signs include bone bruising, meniscal tears, anterior subluxation of the tibia and other ligamentous injuries. 2001;30(6):312315. That is usually the journal article where the information was first stated. A total of 313 knees in 292 patients were included in the nine studies. Roberts CC, Towers JD, Spangehl MJ et-al. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee. Would you like email updates of new search results? Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population-A 2-Year Follow-up Study. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Orthop Traumatol Surg Res. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). proposed a different intervention called reduction plasty, whereby the hypertrophic ACL is reduced to normal size without excision of all mucoid substance [17]. PMC (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). The mean age of patients ranged from 31 to 78years. official website and that any information you provide is encrypted Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Arch Orthop Trauma Surg. Score: 4.7/5 (45 votes) . The mean age at the time of surgery was 57 years (range, 31 to 78 years). ACL debridement was partial in all studies except for those by Lintz et al. The authors declare that they have no competing interests. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. -Evaluated and planned treatment protocol in accordance with physician. 5. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. The total number of patients with symptomatic instability was 18 out of 288 (6%). -, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. 2012 Sep;46(5):561-5. doi: 10.4103/0019-5413.101037. The anterior cruciate ligament (ACL) is an important ligament in the knee. The rate of association between meniscal tears and MDACL ranged from 9 to 96%. Magn Reson Imaging Clin N Am. There is strong association between MDACL and chondral and meniscal lesions, which may support the theory that MDACL is a degenerative process. Symptomatic ACL mucoid degeneration in middle-age athletes. 1. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. The lesion may manifest as an elongated cyst along the long axis of the ACL, or as an enlarged ACL. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2010 Jun 1;96(4):400-6. and transmitted securely. IV (retrospective cohort study). Therefore, indications for ACL resection must be carefully selected. Partial/Total ACL resection arthroscopically- There is marked improvement in the range and reduced posterior pain, but at the cost of increased post-operative knee laxity. Pain was posterior in 23 knees (80%). HHS Vulnerability Disclosure, Help what causes mucoid degeneration of acl. Methods: Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). volume33, Articlenumber:26 (2021) Furthermore, this raises the question as to whether the symptoms (pain and diminished range of movement) were solely due to MDACL and not secondary to other associated pathological conditions. Anterior knee pain is the more common complaint. What is Anterior Cruciate Ligament Mucoid Degeneration? Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. The site is secure. Later studies reported that changes consist of mucoid Results degeneration, neovascularisation, and tendon sheath hyper- Nineteen patients met the inclusion criteria and were inclu- trophy. to 44% in the study of Cha et al. This did not appear to affect the postoperative rate of clinically detectable laxity, which was comparable to that in other studies. It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. statement and Questions just answered: mucoid degeneration of acl physiotherapy. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. 2. sharing sensitive information, make sure youre on a federal Diet therapy and various other treatments (general aspects) Discipline Radiotherapy. 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. AJR Am J Roentgenol. 1. Anterior cruciate ligament ganglia and mucoid degeneration: Coexistence and clinical correlation. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. 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 mucoidlike substance, [1,2 . Knee Surg Sports Traumatol Arthrosc. . 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. There was strong association with chondral lesions and meniscal tears. Typically patients present with knee pain or restricted movement, although often other potential causes for the patient's symptoms are found. It may lead to knee pain. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. 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. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Only nine studies met our inclusion criteria and they were all case series. Each study was scored 02 on each question, with a global ideal score of 16. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. 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). A June 2018 MRI of the cervical spine found multilevel degenerative changes of the cervical spine, most pronounced at 6-7 and small disc herniations at 5-6 and C4-5, with slight interval progression at 5-6. . Read More Created for people with ongoing healthcare needs but benefits everyone. Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased signal intensity and a celery stalk appearance of intact fibers. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Skeletal Radiol. Keywords: 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. TS designed the project, literature search and wrote the manuscript. J Chin Med Assoc. FOIA 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. J Orthop. 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. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Epub 2021 Mar 8. Epub 2008 Dec 17. What causes mucoid degeneration of ACL? Sweed, T., Mussa, M., El-Bakoury, A. et al. However, the authors did not report whether there were any other patients with symptomatic instability. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart illustrating the selections of trials included in the systematic review. Bookshelf Characteristic: "celery stalk" appearance. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. Mucoid degeneration of the anterior cruciate ligament. We herein describe a case of PCL mucoid degeneration presented with secondary ACL . . 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Learn how we can help 704 views Reviewed >2 years ago Thank However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. It is a chronic degenerative change of a bulky ACL that may lead to notch impingement syndrome in the absence of instability symptoms and significant trauma history [ 1, 2, 3, 4 ]. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Federal government websites often end in .gov or .mil. A total of nine studies were eligible for review. Epub 2011 Feb 18. 2012;4 (2): 167-70. Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. https://doi.org/10.4055/cios.2018.10.3.307, University Hospitals of Derby and Burton, Uttoxeter Rd, Derby, DE22 3NE, UK, Trauma and Orthopaedic Speciality Trainee, West Midlands Deanery, Birmingham Rotation, Birmingham, UK, University Hospitals Plymouth NHS Trust, Plymouth, UK, University of Alexandria, Alexandria, Egypt, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK, You can also search for this author in https://doi.org/10.4103/0019-5413.128765, Article California Privacy Statement, Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. Would you like email updates of new search results? Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. (10%) and highest in the study of Ventura et al. PMC Fourteen knees (48%) had limited flexion, on average 97 degrees. 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. Arthroscopic findings. 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Along with that, it also controls the internal rotation. 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. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. 2013 Jun 20;15:59. doi: 10.11604/pamj.2013.15.59.2534. However, in most studies a proportion of patients simultaneously underwent other arthroscopic procedures for associated pathological knee conditions (44% meniscectomies in the study of Cha et al.). Management of mucoid degeneration of the anterior cruciate ligament: a systematic . This site needs JavaScript to work properly. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. government site. Unable to process the form. 4. 1173185. and transmitted securely. Papadopoulou P. The celery stalk sign. government site. The mean MINORS score was 9.5 out of 16 (412). The minimum follow-up was 3 years. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid (A) Bulging of the hypertrophied anterior cruciate ligament. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Cite this article. Physical therapy typically begins 7-10 days after the procedure. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. J Arthrosc Joint Surg 3(1):2833. bling. (61years), which was the largest study and represented more than one third of the total patients included in this review. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. Clipboard, Search History, and several other advanced features are temporarily unavailable. Postoperative symptomatic instability was not common in eight studies, but was observed in 48% of patients in the study of Lintz et al., with two patients having a delayed ACL reconstruction. Epub 2010 May 8. 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. An official website of the United States government. and Ventura et al. Therefore, indications for ACL resection must be carefully selected. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. 3. Dietary management and various treatments Scanning and diagnostic . All patients (100%, n=11) reported a good to very good surgery satisfaction. National Library of Medicine See this image and copyright information in PMC. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Morice et al. 8600 Rockville Pike Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. The cause is not really known, but patients usually do not complain of instability. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. What Is Mucoid Degeneration of the ACL? 2011 Aug 1;19(8):1326-33. Multiple theories have been put forth that explains the pathological disorganization in the collagen fibers of the Anterior Cruciate Ligament, such as synovial, traumatic, and degenerative, "Synovial theory- states that there is accumulation of synovial fluid inside the substance of ACL in a herniated pouch of synovium. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Physical Therapy. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. Results: The rate of simultaneous meniscectomy ranged from 13 to 44%. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Provided by the Springer Nature SharedIt content-sharing initiative. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. FOIA Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. All nine included studies utilized MRI of the knee to establish a radiological diagnosis as an inclusion criterion.
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