physiotherapy for mucoid degeneration of acl
Sports medicine & outpatient orthopedics. It can be misdiagnosed a partial ACL tear. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. Advertising revenue supports our not-for-profit mission. PubMed Central Grade 1A laxity on Lachmans test (less than 5mm translation with a firm end-point) was noted in 27 knees (11.95%) intra-operatively in group B or those who underwent debulking (nb=226), whereas a firm endpoint with no translation was noted in all of the remaining 199 knees (88.05%). 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). Laskowski ER (expert opinion). 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). . Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Do any specific movements seem to improve or worsen your symptoms? Sixty-one patients underwent T2*WI and PDWI at 3, 6, and 12 months postoperatively. Treatment Notes prior to January 29, 2019 . Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity with disputed theories of origin [1,2,3,4]. Int J Curr Res Acad Rev 4(11):1824. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. https://doi.org/10.1016/j.knee.2010.05.003, Keyes GW, Carr AJ, Miller RK, Goodfellow JW (1992) The radiographic classification of medial gonarthrosis. However, young patients . "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Provided by the Springer Nature SharedIt content-sharing initiative. 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. (4a) 3D rendering of an ACL ganglion viewed from the medial side with the medial femoral condyle removed. Management of mucoid degeneration of the anterior cruciate ligament: a systematic . 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. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. 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. 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. Depending on the severity of your injury, you may be referred to a doctor specializing in sports medicine or a specialist in bone and joint surgery (orthopedic surgeon). . Indian J Orthop 46(5):561565. In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. Follow the R.I.C.E. The results found improved functional scores and pain scores compared with preoperative levels. Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. Extraligamentous extension into the joint and intercondylar notch produces a higher incidence of mechanical symptoms (7a). Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament Clinics in Orthopedic Surgery Vol. There is little evidence investigating the effect of MD-ACL in patients undergoing a UKA in the orthopaedic literature. 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. Such meniscal tears are not appropriate for repair most of the time (Fig. Knee 18(3):168171. Without adequate and timely treatment, . Google Scholar, White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. This replacement tissue is called a graft. [2]. 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). 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. CAS The treatment alternatives, indications for the planned procedure and risks were discussed with her in detail and an informed consent was obtained. As per study population statistics, the prevalence of medial meniscus tears (29.64%) in this study were congruent to the rates found in studies by Srivastava etal. https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/. Google Scholar, Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A (2021) Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. These patients who underwent UKA with debulking of MD-ACL were included in group B (nb=226). PubMed We describe Arthroscopic near total debridement of mucoid degenerated ACL in . Amyn M. Rajani. The soft-tissue thickening and increased signal intensity along the course of the ligament with either form of cyst may be confused with the appearance of an ACL tear. Once considered a rare disease, it is probably a less diagnosed condition of knee pain. These tests may include: Prompt first-aid care can reduce pain and swelling immediately after an injury to your knee. The patients clinical history and symptoms do not support an ACL injury. Inclusion criteria was as follows: (1) clinicoradiological confirmation of MD-ACL and medial compartment osteoarthritis (MCOA) of the affected knee joint; (2) patients with less than 10 of varus or 5 of valgus deformity and (3) patients with no flexion contracture. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. These cysts have a variable MR appearance and are not always confined to the substance of the ligament. With the advent of the mobile-bearing UKA system, the predilection towards this surgery is on an upward trend. The severity of the ACL injury is graded from 1 to 3. Your 3-year nephew sta News comes out day after day about sexual harassment. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. [21]. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. Mucoid degeneration of the ACL is a very rare cause of knee pain. (Tr. All rights reserved. 4 McIntyre J, Moelleken S, Tirman P: Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Papers of special note have been highlighted as: of interest. 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. Before an appointment, be prepared to answer the following questions: Mayo Clinic does not endorse companies or products. It can be secondary to trauma, or simply degeneration caused by meniscal injury, osteoarthritis or chondral damage [2]. Most surgeons recommend a program of physical therapy post-operatively to reduce pain and swelling, promote full range-of-motion, and improve knee function. Mucoid degeneration of ACL. Make a donation. The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case series. 2022 - 2023 Times Mojo - All Rights Reserved Subsequently, the final sample included 442 patients who were followed-up for at least 2years after surgery (Fig. -Delivered Pre-rehab care for breast cancer and thoracic cancer cases. was responsible for physiotherapy, writing review, editing and project administration. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. The severity of the ACL injury is graded from 1 to 3. 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. in this condition your acl (anterior cruciate ligament) filled with jelly like material and it thickened so space in intercondylar resion of knee joint is reduced. The ligament can also tear due to work injuries or automobile accidents. There was a statistically significant improvement in the mean IKDC and mean KSS of both the groups at 2years of follow-up as compared with their pre-operative scores (p<0.05). J Orthop Traumatol. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion. I have multiple issues spondylolisthesis in L4/L5 and L5/S1, osteopenia and osteoarthritis. Histopathological confirmation of mucoid degeneration was obtained in all 442 patients. . Complete your request online or contact us by phone. Questions just answered: mucoid degeneration of acl physiotherapy. . There have been only some reported cases of mucoid degeneration of the ACL in the English literature. Scribd adalah situs bacaan dan penerbitan sosial terbesar di dunia. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. UKA by itself improves the functional and clinical outcome of patients with medial compartment osteoarthritis. 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. . (wikipedia.org)Rarely, intraosseous ganglion cysts occur, sometimes in . 21 yrs old Male asked about Mucoid degeneration of ACL, 2 doctors answered this and 92 people found it useful. Mucoid degeneration of the anterior cruciate ligament (ACL) is a common pathology but is often unknown and underdiagnosed. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin. Friedberg RP. 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. Sun H, Gill TJ. 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. 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. I remember that Dr. Jain came out from his clinic to see my mother because my mother was not able walk a single step. The authors did not perform stress tests. At arthroscopy, the ACL appeared homogenous, bulbous, and hypertrophied in all patients. How common is mucoid degeneration of the ACL? Mucoid degeneration of ACl is a rare pathological process involving knee joint. 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. 18 Apr 2021. #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. (Table 2). The most common cause of meniscus tears is age related degeneration. Reeducation. An ACL sprain is when the ACL is overstretched (but not torn). model of self-care at home: Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. 2023 BioMed Central Ltd unless otherwise stated. This content does not have an Arabic version. However, the terminal ROM achieved after debulking MD-ACL was significantly better (p<0.05) at 2years of follow-up as compared with the group that did not undergo debulking. After surgery you'll resume another course of rehabilitative therapy. 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. As previously reported, typical symptoms of mucoid degeneration of the ACL include knee pain during deep flexion and painful limitation of motion. Signs and symptoms: It usually affects middle aged and elderly people. 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. : any of various mucoproteins that occur especially in secretions of mucous membranes. Am J Sports Med 29(5):600613. This denoted adequate release of the impinging fibers against the lateral femoral condyle, femoral notch and PCL. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. 2). The rest of the surgery remained the same and all patients underwent mobile-bearing Oxford UKA. Am J . By continuing to browse this site, you accept our, International Journal of Endocrine Oncology, International Journal of Hematologic Oncology, Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C, Mucoid metaplastic-degeneration of anterior cruciate ligament, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR, Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation, Makino A, Pascual-Garrido C, Roln A, Isola M, Muscolo DL, Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK, Mucoid cystic degeneration of the cruciate ligament, Mucoid degeneration of the anterior cruciate ligament, Arthroscopic management of mucoid degeneration of anterior cruciate ligament, Pandey V, Suman C, Sharma S, Rao S, Kiran Acharya K, Sambaji C, Mucoid degeneration of the anterior cruciate ligament: management and outcome, Mucoid degeneration of the anterior cruciate ligament: a case report and review of literature, Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D, Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J, Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament, Kim T-H, Lee D-H, Lee S-H, Kim J-M, Kim C-W, Bin S-I, Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament, Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA, Platelet-rich plasma: from basic science to clinical applications, Southworth T, Naveen N, Tauro T, Leong N, Cole B, The use of platelet-rich plasma in symptomatic knee osteoarthritis, Vogrin M, Rupreht M, Crnjac A, Dinevski D, Krajnc Z, Renik G, The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study, Partial anterior cruciate ligament ruptures: advantages by intraligament autologous conditioned plasma injection and healing response technique midterm outcome evaluation, Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears, Rating systems in the evaluation of knee ligament injuries, Hensen JJ, Coerkamp EG, Bloem JL, Schepper AMD, Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage, Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P, Anterior cruciate ligament mucoid degeneration: selecting the best treatment option, Zicaro JP, Yacuzzi C, Garcia-Mansilla I, Costa-Paz M, Nonsurgical treatment of partial ACL tears: intraarticular injection of platelet-rich plasma did not change the progression rate to knee instability, Seijas R, Ares O, Cusc X, lvarez P, Steinbacher G, Cugat R, Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors, Long-term outcomes of primary repair of the anterior cruciate ligament combined with biologic healing augmentation to treat incomplete tears, McRobb J, Kamil KH, Ahmed I, Dhaif F, Metcalfe A, Influence of platelet-rich plasma (PRP) analogues on healing and clinical outcomes following anterior cruciate ligament (ACL) reconstructive surgery: a systematic review. California Privacy Statement, Dietary management and various treatments Scanning and diagnostic . 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. The excised ACL tissue was sent for histopathological confirmation of mucoid degeneration. The power of the study for the corrected model was estimated to be 92% for the aforementioned sample size when keeping the value of as 0.05, the degree of freedom (df) as 1, and adjusted R2 as 0.023. Treatment: For symptomatic knees surgical debulking /debridement in which thickened part of the ACL is shaved off, is the treatment of choice. It is postulated that mucoid degeneration may be a predisposing factor to the formation of ACL ganglion cysts . He did total knee replacement on both side and now my mother is walking without aid. Accessed Nov. 21, 2018. The authors presume that this objective end point suggests adequate debulking, just enough to remove the impingement factor from the lateral femoral condyle, femoral notch and PCL, and consequently the symptoms associated with the impingement. No writing assistance was utilized in the production of this manuscript. PubMedGoogle Scholar. K Munde: Substantial contributions to the design of the work, analysis of the data for 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. ACL ganglion cyst occurs more frequently among relatively younger patients compared to mucoid degeneration. [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. It is postulated that intraosseous extension may be a finding more often associated with pain (8a). 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. M.P. All the patients were operated on in a leg hanging position and under tourniquet control. 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. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Contact us. 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].
