Google Scholar, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Truncation means that the . Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Advertising revenue supports our not-for-profit mission. Anterior knee pain is the more common complaint. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. This allows the doctor to see the knee structures more clearly. Methodology: Five patients who were diagnosed as a case . Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Provided by the Springer Nature SharedIt content-sharing initiative. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee. 21 yrs old Male asked about Mucoid degeneration of ACL, 2 doctors answered this and 92 people found it useful. : tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. It can cause pain and to a meniscal tear. A painful injury where the upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. (wikipedia.org)Rarely, intraosseous ganglion cysts occur, sometimes in . https://doi.org/10.1016/j.knee.2020.06.004, Article Acta Orthop Scand 63(5):497501. Sports medicine & outpatient orthopedics. Mentioning: 2 - We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). c 24.5months post-operative radiograph showing no posterior translation of femur compared with pre-operative and immediate post-operative radiograph. Mucoid degeneration of the ACL is a rare cause of knee pain in the middle-aged patient group, without knee instability. Accessed Nov. 13, 2018. Follow us on social media for the latest updates, Future Medicine Ltd, Unitec House, 2 Albert Place, London, N3 1QB, UK, We use cookies to improve your experience. 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. Little is known about this condition that affects 1.85.3% of the population as per magnetic resonance imaging (MRI) diagnosis [2, 3]. 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. Google Scholar, Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. What is one assumption of Freud's psychoanalytic theory? Once considered a rare disease, it is probably a less diagnosed condition of knee pain. The anterior cruciate ligament (ACL) is a key structure in the knee joint kinematics, as it resists anterior tibial translation and rotational loads. Histopathological confirmation of mucoid degeneration was obtained in all 442 patients. A case of mucoid degeneration of the anterior cruciate ligament (ACL) is reported based on specific imaging features on MRI. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. Go to the Bones, Joints & Muscles Support Group. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee . PubMed https://doi.org/10.1177/03635465010290051301, Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. 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. Accessed Nov. 13, 2018. 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. Discrete intraosseous ganglia are observed in 3/4 of the cases with mucoid degeneration of the ACL. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. This study holds clinical significance in terms of the very limited literature available on the role of MD-ACL in outcomes of patients undergoing UKA. These patients were included in group A (na=216). Do you ever feel that your knee is unstable or unable to support your weight? 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. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Additional Professor, Department of Orthopaedics, AIIMS Jodhpur, Jodhpur, Rajasthan, 342005, India, Senior Resident, Department of Orthopaedics, AIIMS Jodhpur, Jodhpur, Rajasthan, 342005, India. Mucoid degeneration of the ACL is a very rare cause of knee pain. PubMed TimesMojo is a social question-and-answer website where you can get all the answers to your questions. The most common mechanism is that of a sudden pivoting or cutting maneuver during sporting activity, which is commonly seen in football, basketball and soccer. The Infona portal uses cookies, i.e. If nothing is done, the ACL injury may turn into chronic ACL deficiency. RADIOLOGIC FINDINGS: Left retrograde pyelogram was performed. 5 Stoller DW: Magnetic Resonance Imaging in Orthopaedics and Sports Medicine . 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. Treatment is only required if there are otherwise unexplained symptoms. 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. 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. 3 Do-Dai DD, Youngberg RA, Lanchbury FD, et al: Intraligamentous ganglion cysts of the anterior cruciate ligament: MR findings with clinical and arthroscopic correlations. fatty degeneration deposit of fat globules in a tissue. The rest of the surgery remained the same and all patients underwent mobile-bearing Oxford UKA. . DeLee JC, et al. Treatment Notes prior to January 29, 2019 . It is postulated that intraosseous extension may be a finding more often associated with pain (8a). California Privacy Statement, 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. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. However, young patients . Sep 2017 - Feb 20186 months. Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. Have your symptoms been continuous or occasional? 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. All the demographic and biostatistical data was compiled and computed on the SPSS-24 software. 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. However, in some patients, ACL ganglion cysts cause significant clinical symptoms. Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Setback to comeback: Twin sisters return to the basketball court after ACL tears, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, NSF Certified for Sport Nutritional Supplements. just over two decades ago [1], the interest in this condition has quickly gathered pace in the orthopaedic community. on nine studies [8]. (8a) Intraosseous extension of an ACL ganglion. There's no set time frame for athletes to return to play. Predetermined inclusion and exclusion criteria were used for sample collection. 1 Brown MF, Dandy DJ: Intra-articular ganglia in the knee. Rajani, A.M., Shah, U.A., Mittal, A.R.S. Justamom21. 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. Knee Surg & Relat Res 34, 40 (2022). This was confirmed at 2years follow-up, when the patients who underwent debulking showed a statistically significant improvement in in mean terminal flexion by 21.51 in group B (mean pre-operative: 96.3855.78; mean post-operative: 117.892.64) as compared with 5.02 in group A (mean pre-operative: 98.0934.79; mean post-operative: 103.114.1). The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid model of self-care at home: Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. Dr. Anil K. Sharma. The purpose of this study was to diagnose mucoid degeneration of ACL and to assess the effectiveness of arthroscopic treatment in these patients. It is a very rare cause of knee pain and can be diagnosed preoperatively on MRI. By using this website, you agree to our -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. 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. The time it takes to recover is approximately 3 months. interval progression at C5-6. 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. The left ureter was normal in the pelvis. . A coordinator will follow up to see if Mayo Clinic is right for you. Connect with thousands of patients and caregivers for support and answers. https://doi.org/10.3109/17453679209154722, Gibson PH, Goodfellow JW (1986) Stress radiography in degenerative arthritis of the knee. J Bone Jt Surg Ser B 81(2):304305. J Comput Assist Tomogr 1996 Jan-Feb; 20(1): 80-4. Rehabilitation, orthophony, crenotherapy. A single copy of these materials may be reprinted for noncommercial personal use only. ACL ganglion cyst occurs more frequently among relatively younger patients compared to mucoid degeneration. Despite integrity and status of cruciates being paramount in a UKA, no study has evaluated the effect of debulking MD-ACL in this procedure. Journal of the American Academy of Orthopaedic Surgeons. Injury prevention. Although asymptomatic in most cases, MD-ACL has been associated with posterior knee pain and restriction of terminal flexion or extension, in addition to pain and discomfort after sitting for a prolonged period of time [4, 5]. 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. Autologous PRP, prepared by double spin protocol, was injected into the remaining ACL after partial debridement was done. It can cause pain and to a meniscal tear. What are the findings? Therefore, indications for ACL resection must be carefully selected. This study used PRP to augment the weakened ACL and followed patients for 1 year to assess outcomes. 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 . 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. This content does not have an English version. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. Arthroscopic surgeries are key hole surgeries for joint disorders. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears . 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. Mucoid degeneration of anterior cruciate ligament (ACL) 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. Main symptoms are pain during terminal knee flexion (as in squatting) feeling of heaviness/tiredness in the knee. Anterior Cruciate Ligament, is an important structure of the knee joint. https://doi.org/10.1007/s00167-012-1991-9, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. Rehabilitation, speech therapy, crenotherapy. One MRI was reported as a possible ganglion cyst or mucoid degeneration of the ACL, whereas all others were reported as either partial or complete tears of the ACL. It is postulated that mucoid degeneration may be a predisposing factor to the formation of ACL ganglion cysts . Laskowski ER (expert opinion). It can be misdiagnosed a partial ACL tear. Am J Roentgenol 182(5):12831287. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Privacy It is commonly associated with characteristic clinical findings such as progressive knee pain and discomfort on prolonged sitting or standing in a fixed posture, without history of a significant trauma or instability preceding the symptoms. These tests may include: Prompt first-aid care can reduce pain and swelling immediately after an injury to your knee. (Tr. How common is mucoid degeneration of the ACL? These ganglia consist of myxoid material. ACL Injury Grades. . Such meniscal tears are not appropriate for repair most of the time (Fig. Among other conditions - osteoarthritis, osteopenia, spondylolisthesis- an MRI report showed "severe mucoid degeneration of the ACL" in my left knee. statement and The ligament can also tear due to work injuries or automobile accidents. Papers of special note have been highlighted as: of interest. 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. A.R. This course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees. They are relatively uncommon, and their exact aetiopathogenesis is still not clear. At the time of the injury, a "pop" or "snap . UKA by itself improves the functional and clinical outcome of patients with medial compartment osteoarthritis. At minimum 2years post-operatively, patients were called for a follow-up, and they were assessed clinically for ROM and stability by a blinded clinician not involved in the clinical care of the patients. In: Current Medical Diagnosis & Treatment 2019. The outcome analysis of both groups was done using the same follow-up protocol in terms of time (2years post-operatively), clinical tests (Lachmans test), functional scoring systems [IKDC score, KSS, rest pain by visual analogue scale (VAS)] and subjective patient satisfaction. 58th ed. This site complies with the HONcode standard for trustworthy health information: verify here. 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]. Did you hear a loud pop or feel a "popping" sensation? An ACL sprain is when the ACL is overstretched (but not torn). Part of These cysts have a variable MR appearance and are not always confined to the substance of the ligament. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. [5] and Chudasama etal. In terms of treatment, doctors mostly recommend an arthroscopy, a minimally invasive surgical procedure which examines and sometimes . 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 . He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. 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. The pathogenesis of mucoid degeneration is unclear, but injury, ganglion cysts, and degenerative process have been implicated as the most likely etiologic factors in the production of this change. You can read more if you want. J Bone Jt Surg Br 93(4):4768. . Accessed Nov. 13, 2018. ACL Injury Grades. . 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. Lippincott-Raven; 1997. . Why Do Cross Country Runners Have Skinny Legs? These findings were in line with the findings published by Cha etal. 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. 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. After surgery you'll resume another course of rehabilitative therapy. We describe Arthroscopic near total debridement of mucoid degenerated ACL in . (2a) T1-weighted sagittal image demonstrates an enlarged, club-shaped anterior cruciate ligament (arrows). 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. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. 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.