In general, it takes as long as a year or more before athletes can safely return to play. J Orthop Traumatol. However, in some patients, ACL ganglion cysts cause significant clinical symptoms. A pre-study power analysis was done for a minimum sample size of 400, using dependent and independent variables involved in the study outcome. The appearance can mimic acute or chronic interstitial partial tears of the ACL. 2015;23:283. 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. Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.817.97 years (42-74 years). was the primary surgeon and was responsible for the conceptualization, methodology, supervision, writing review and editing. The severity of the ACL injury is graded from 1 to 3. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. If your activities do not involve making pivoting movements on the knee, physical therapy rehabilitation may be all you need. 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. Usually there is no history of any significant trauma. In terms of treatment, doctors mostly recommend an arthroscopy, a minimally invasive surgical procedure which examines and sometimes . The abnormal sliding within the knee also can hurt cartilage. 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. RADIOLOGIC FINDINGS: Left retrograde pyelogram was performed. All Rights Reserved. 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). The anterior cruciate ligament (ACL) is the most commonly injured of the major knee ligaments. 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. 2). The rest of the surgery remained the same and all patients underwent mobile-bearing Oxford UKA. Discussion: Treatment of ACL mucoid degeneration by arthroscopic resection is effective for . [4]showed high percentages of laxity post debulking of MD-ACL, a finding which would not allow a surgeon to carry out a UKA after the debulking. 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. This is a characteristic appearance of ACL mucoid degeneration where the ACL is expanded and hyperintense but is still continuous with normal alignment. Lachmans test was performed intra-operatively in the immediate aftermath of the debulking, and only 27 (11.95%) knees were found to have grade one laxity with a firm end point, while no laxity was noted in the other knees. It can cause pain and to a meniscal tear. Connect with thousands of patients and caregivers for support and answers. 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. J Sports Med Phys Fit 48(4):483487, CAS Ellman MB, et al. The median age of the affected population is estimated to be 51years [5]. Is this likely to cause my knee pain or can it be the compressed lumbar nerve or both? 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. Patient having mucoid degeneration of ACL seeks multiple orthopedic consultation and most of the time treating orthopedican miss its diagnosis either because of lack of experience or rare cause of pain unless doctor sought magnetic resonance imaging (MRI) of knee. J Bone Jt Surg Br 73(4):582586. 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 ., Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity with disputed theories of origin [1,2,3,4]. 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. 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. 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]. Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. 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]., Pandit H, Gulati A, Jenkins C (2011) Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment. Mucoid degeneration of the ACL is a very rare cause of knee pain. 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. Discrete intraosseous ganglia are observed in 3/4 of the cases with mucoid degeneration of the ACL. What is your diagnosis? 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears . 2014;42:1567. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. 1). Knee Surg & Relat Res 34, 40 (2022). TimesMojo is a social question-and-answer website where you can get all the answers to your questions. 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. Laskowski ER (expert opinion). Home | About | Contact | Copyright | Report Content | Privacy | Cookie Policy | Terms & Conditions | Sitemap. Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. It can trap and damage the menisci in the knee and can also lead to early osteoarthritis. Get your query answered 24*7 only on | Practo Consult . Methodology: Five patients who were diagnosed as a case . I remember that Dr. Jain came out from his clinic to see my mother because my mother was not able walk a single step. Dietary management and various treatments Scanning and diagnostic . In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. Manage cookies/Do not sell my data we use in the preference centre. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. 1998-2023 Mayo Foundation for Medical Education and Research. 2nd ed. Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament Clinics in Orthopedic Surgery Vol. . These ganglia consist of myxoid material. It can be misdiagnosed a partial ACL tear. 3). Enter your email address below and we will send you the reset instructions. This study used PRP to augment the weakened ACL and followed patients for 1 year to assess outcomes. 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. 2022 - 2023 Times Mojo - All Rights Reserved There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. However, a predetermined list of criteria has been compiled over the years based on findings in published reports within which a patient needs to fall so as to be eligible to undergo a UKA. (Tr. The ACL provides approximately 85% of the total restraining force of anterior translation. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Very minor tears (sprains) may heal with non-surgical treatments and regenerative medicine therapy. An anteriorly protruding ganglion (arrow) arising from an ACL ganglion cyst (arrowheads) is well seen on a proton density-weighted sagittal image. The ligament can also tear due to work injuries or automobile accidents. The left ureter was normal in the pelvis. Anterior and posterior cruciate ligament ganglion cysts are reported in the literature as being rare with an incidence of approximately 0.5% to 1%.1,2 However, in our experience, this entity is encountered more commonly, most often within the anterior cruciate ligament. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. If the address matches an existing account you will receive an email with instructions to reset your password. The authors acknowledge some limitations to this study. Patient is advised to do exercises to get movement and strength again following surgery. All 5 patients under- went arthroscopic surgery. It is postulated that intraosseous extension may be a finding more often associated with pain (8a). The pain and disability associated with an ACL injury prompt many people to seek immediate medical attention. Without a properly functioning ACL, the other structures of the knee experience greater strain, which causes further injuries to tissues in the knee. J Arthosc 6:322, 1990. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. Sun H, Gill TJ. It results in postoperative laxity, but rarely in frank instability. Freedom from war and natural disaster. Please check your URL or use the search form below. 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. Intraosseous ganglion 6. ACL Reconstruction is a surgical procedure to reconstruct the ligament in the center of your knee in order torestore its function after an injury. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Injury prevention. These appearances must be differentiated from mucoid degeneration of the intact ACL. Background: There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). With debulking of MD-ACL being a relatively newer concept and insufficient data backing the eventual stability of the ACL, the surgeons primarily performed UKA without debulking in MD-ACL, until December 2018. 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]. 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 These are found inside your knee joint. [7] have documented the presence of flexion contracture, we did not notice the same in any patient from the recruited sample size. 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. 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 severity of the ACL injury is graded from 1 to 3. 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. 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. Before an appointment, be prepared to answer the following questions: Mayo Clinic does not endorse companies or products. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Treatment Notes prior to January 29, 2019 ., Mulligan EP, McGuffie DQ, Coyner K, Khazzam M (2015) The reliability and diagnostic accuracy of assessing the translation endpoint during the lachman test. 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. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. (2a) T1-weighted sagittal image demonstrates an enlarged, club-shaped anterior cruciate ligament (arrows). 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. Your knee may become more and more unstable and may give out more often. Anyone else have this and how was it treated if at all? They offer less hospital stay and speedy recovery. [22], Pandey etal. A longer recovery period may reduce the risk of re-injury. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. T2-weighted sagittal view demonstrates localized fluid signal within the ACL (arrows). (8a) Intraosseous extension of an ACL ganglion. Hence, we targeted a minimum sample size of 400 patients. It also prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses [1]. On table, the extent of impingement caused by the mucoid degeneration was gauged using an arthroscopy hook. 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. With the advent of the mobile-bearing UKA system, the predilection towards this surgery is on an upward trend. Purpo. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Do any specific movements seem to improve or worsen your symptoms? A painful injury where the upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues. The cause is not really known, but patients usually do not complain of instability. Ganglion cysts are filled with gelatinous and viscous fluid in the neighbourhood of joints or tendon sheaths. This is done arthroscopically (arthroscopic/key hole surgery). 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. 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. Close. Flowchart representation of selection process of sample size, intervention process and outcome assessment. Medical Definition of mucoid degeneration. Amyn M. Rajani. Love. A single copy of these materials may be reprinted for noncommercial personal use only. 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). 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. Rehabilitation, orthophony, crenotherapy. During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon tissue similar to a ligament that connects muscle to bone. The most common cysts in the knee region are popliteal also called Bakers cysts. This article belongs to the Special Issue on Radiation Therapy in the Treatment of Cancer < 1 2 3. 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]. MRI has been established as the gold standard imaging modality for the diagnosis of MD-ACL based on the criteria laid out by Bergin etal. 10, No. 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. c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. Mucinous material within the substance of ACL produces pain and limited motion in the knee. UKA by itself improves the functional and clinical outcome of patients with medial compartment osteoarthritis. Arthrosc Tech 7(5):e459e463. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. Advertising revenue supports our not-for-profit mission. (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. Flag this answer., Keyes GW, Carr AJ, Miller RK, Goodfellow JW (1992) The radiographic classification of medial gonarthrosis. Provided by the Springer Nature SharedIt content-sharing initiative. 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. Which Teeth Are Normally Considered Anodontia. How long does it take an ACL to heal without surgery? Dr. Anil K. Sharma. Intraosseous increased signal is present within the tibial spine deep to the posterior extent of the ACL insertion (arrowhead). Indian J Orthop 46(5):561565. 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. (6a) "Celery stalk" form of ACL ganglion cyst. Anterior Cruciate Ligament, is an important structure of the knee joint.
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