Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings

Makino, Arturo; Pascual‐Garrido, Cecilia; Rolon, Alejandro; Isola, Mariana; Múscolo, D. Luis

doi:10.1007/s00167-010-1239-5

Cited by 50 publications

(46 citation statements)

References 12 publications

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“…MD is a rare pathology of ACL12345 and usually affects middle aged individuals with mean age of 42 years 2458913. Kim et al .…”

Section: Discussionmentioning

confidence: 99%

“…Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare pathological entity with disputed theories of origin 12345. It is characterized by infiltration of mucoid like substance (glycosaminoglycans) interspersed within the substance of ACL causing knee pain and limited motion.…”

Section: Introductionmentioning

confidence: 99%

“…review of 4221 knee magnetic resonance imaging (MRI) revealed that 1.8% ( N = 74) of knees can be affected with MD ( N = 17) and mucoid cyst ( N = 57) 8. Regarded as a rare occurrence in the past, of late many reports of MD have highlighted the fact that it is not a rare entity and possibly was under diagnosed or misdiagnosed and reported as partial or complete tear of ACL 23579101112. The Purpose of this prospective study is to discuss the clinical, radiological, arthroscopic features, treatment and outcome in eleven such patients.…”

Section: Introductionmentioning

confidence: 99%

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Mucoid degeneration of the anterior cruciate ligament: Management and outcome

Pandey

Suman

Sharma

et al. 2014

IJOO

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Background:Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Mucinous material within the substance of ACL produces pain and limited motion in the knee. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes.Materials and Methods:During a period of 3 years, 11 patients were included based upon the clinical suspicion, magnetic resonance imaging (MRI) findings, arthroscopic features and histopathologic confirmation of MD of ACL.Result:Six patients were male and five were female with median age of 40 years (range 21-59 years). All patients complained of knee pain with median duration of 5 months (range 1-24 months). All patients had painful deep flexion with 63.6% (N = 7) reporting trivial trauma before the onset of symptoms. MRI revealed MD of ACL in all with associated cyst in three patients. Partial debridement of ACL was done in ten and complete in one patient. None of them required notchplasty. Histopathology confirmed the diagnosis in all of them. At the mean followup of 13.81 months (range 6-28 months), all patients regained complete flexion and none complained of instability.Conclusion:Prior knowledge of condition with high index of suspicion and careful interpretation of MRI can establish the diagnosis preoperatively. It responds well to partial debridement of ACL and mucinous material without development of instability.

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“…MD is a rare pathology of ACL12345 and usually affects middle aged individuals with mean age of 42 years 2458913. Kim et al .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mucoid degeneration of the anterior cruciate ligament: Management and outcome

Pandey

Suman

Sharma

et al. 2014

IJOO

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“…The symptoms started insidiously, had a mean duration of 21 months (range 12–47 months) without preceding significant trauma. Eighteen patients had extension deficit and two patients had limited flexion 34. There was medial joint pain in two patients.…”

Section: Methodsmentioning

confidence: 98%

Arthroscopic management of mucoid degeneration of anterior cruciate ligament

Chudasama

Prabhakar

2012

IJOO

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Background:Mucoid degeneration of the anterior cruciate ligament (ACL) is a less understood entity. 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 Methods:Between December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis of magnetic resonance imaging (MRI), histopathology, and arthroscopy findings. 12 patients were males and 8 patients were females, with mean age of 42.2 years for males (range 28-52 years) and 39.4 years for females (range 30–54 years). They presented with pain on terminal extension (n=10) and on terminal flexion (n=2) without history of significant preceding trauma. MRI showed an increased signal in the substance of the ACL both in the T1- and T2-weighted images, with a mass-like configuration that was reported as a partial or complete tear of the ACL by the radiologist. At arthroscopy, the ACL was homogenous, bulbous, hypertrophied, and taut, occupying the entire intercondylar notch. A debulking of the ACL was performed by a judicious excision of the degenerated mucoid tissue, taking care to leave behind as much of the intact ACL as possible. Releasing it and performing a notchplasty treated impingement of the ACL to the roof and lateral wall. In one patient, we had to replace ACL due to insufficient tissue left behind to support the knee.Results:Good to excellent pain relief on terminal flexion–extension was obtained in 19 of 20 knees. The extension deficit was normalized in all knees. Lachman and anterior drawer test showed a firm endpoint in all, and 85% (n=17) showed good to excellent subjective satisfaction.Conclusions:Mucoid hypertrophy of the ACL should be suspected in elderly persons presenting pain on terminal extension or flexion without preceding trauma, especially when there is no associated meniscal lesion or ligamentous insufficiency. They respond well to a judicious arthroscopic release of the ACL with notchplasty.

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“…However, not only trauma but also degeneration, edema, bleeding, and inflammation could cause structure alternation of ligaments. It is well documented that degeneration of tendons and anterior cruciate ligaments could cause high-signal changes on MRI [34][35][36]. Although Vetti et al [37] reported that high-signal changes were not related to age and spinal degeneration in their study, histological degeneration of ligaments that were not supposed to increase by age [38,39] still could be a potential reason of MRI signal changes.…”

Section: Discussionmentioning

confidence: 89%

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Shen

2012

Eur Spine J

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Purpose Hypothesis that loss of integrity of the membranes in the craniocervical junction might be the cause of neck pain in patients with whiplash-associated disorders (WADs) has been proposed. In recent years, with development of more detailed magnetic resonance imaging (MRI) techniques, morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed. A metaanalysis was performed to evaluate the relationship of MRI signal changes of alar and transverse ligaments and WADs. Methods A systematic search of EMBASE, PUBMED, and Cochrane Library and references from eligible articles were conducted. Comparative studies reporting on evaluating the relationship between MRI high-signal changes of alar and transverse ligaments and WADs were regarded eligible. A pooled estimate of effect size was produced. Results Alar ligaments: Six studies (total n = 622) were included. MRI signal changes of alar ligaments did not appear to be related with WADs (P = 0.20, OR = 1.54, 95 % CI = 0.80-2.94). Heterogeneity was present (I 2 = 46 %, P = 0.10), which was eliminated upon sensitivity analysis bringing the OR to 1.27 (95 % CI = 0.87-1.86, I 2 = 0 %). Transverse ligaments: Four studies (total n = 489) were included. MRI signal changes of transverse ligament did not appear to be related with WADs (P = 0.51, OR = 1.44, 95 % CI = 0.49-4.21). Heterogeneity was present (I 2 = 77 %, P = 0.005), which was eliminated upon sensitivity analysis bringing the OR to 0.79 (95 % CI = 0.49-1.28, I 2 = 0 %). Conclusion MRI signal changes of alar and transverse ligaments are not supposed to be caused by whiplash injury, and MRI examination of alar and transverse ligaments should not be used as the routine workup of patients with WADs.

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Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings

Abstract: Mucoid degeneration of the ACL can be suspected in patients with posterior knee pain associated with a thickened ACL. Associated findings such as an intraosseous tibial or ganglion cyst help to rule out differential diagnosis.

Cited by 50 publications

References 12 publications

Mucoid degeneration of the anterior cruciate ligament: Management and outcome

Mucoid degeneration of the anterior cruciate ligament: Management and outcome

Arthroscopic management of mucoid degeneration of anterior cruciate ligament

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

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