Anterior Cruciate Ligament (ACL) Mucoid Degeneration: Difference between revisions
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Revision as of 12:39, 20 September 2020
Original Editor - User Name
Top Contributors - Keta Parikh, Kim Jackson and Leana Louw
Introduction[edit | edit source]
Anterior Cruciate Ligament is an important structure of the knee joint. Anatomically, it is arranged in a crossed pattern to the Posterior Cruciate Ligament, therefore, it is also known as cruciform ligament. The ligament conists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively.The cruciate ligament have mechanoreceptors, which are responsible to detect any change in position of the knee, direction, speed and tension. The ligament is mainly responsible for restraning anterior translation of knee. Along with that, it also controls the internal rotation. Therefore, Anterior Cruciate Ligament tear is more susceptible during any injury to the knee.
What is Anterior Cruciate Ligament Mucoid Degeneration?[edit | edit source]
This is a rare pathological condition, in which there is increased signal from within the ligament. Mucoid degeneration, is irreversible degeneration of the tissue with the infiltration of mucin within the fibers[1][2]. Multiple theories have been put forth that explains the pathological disorganisation 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.“Traumatic” theory - post injury, ACL fibroblasts secrete glycosaminoglycans, the mucin substance within the ACL. Other theories include “Degenerative” theory- MD could occur due to ageing.[3]
Clinical Findings[edit | edit source]
Painful terminal knee flexion[2][3]
Stiffness[2]
No extension block[3]
Joint line tenderness[3]
Swelling[3]
Crepitation[3]
Causes[edit | edit source]
Ageing
Primary condition- Osteoarthritis, degenerative menisci, meniscal tear[3], Menisectomy[4]
Complications[edit | edit source]
Impingement of the soft tissue in the vicinity[3]
Ganglionic cyst
Tendon tear/ Tendon rupture
Radiological Findings[edit | edit source]
MRI:[edit | edit source]
Characteristic:"celery stalk" appearance,[4] reflects ACL degeneration.
Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity.[3][4]
Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis.[3][4]
ARTHROSCOPY:[edit | edit source]
Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied, with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL[4]
Differential Diagnosis[edit | edit source]
Conditions that resembles the clinical findings are:
- Ligament tear
- Ligament rupture
- Fatty infiltration
- Ligament sprain
- Ganglion cyst
Treatment[edit | edit source]
- 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.[3][4][5]in some cases,and may lead to instability. The prognosis depends upon the age of the patient, and the associated injuries[2]
- Arthroscopic debridement[4]
- Notchplasty[3][5]
References[edit | edit source]
- ↑ Palmer, W., Bancroft, L., Bonar, F. et al. Glossary of terms for musculoskeletal radiology. Skeletal Radiol 49, 1–33 (2020). https://doi.org/10.1007/s00256-020-03465-1
- ↑ 2.0 2.1 2.2 2.3 2.4 Khalid Ibn el Kadi et al. Mucoid degeneration of the anterior cruciate ligament: a case report. Pan African Medical Journal. 2013;15:59. [doi: 10.11604/pamj.2013.15.59.2534]
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 Pandey, Vivek et al. “Mucoid degeneration of the anterior cruciate ligament: Management and outcome.” Indian journal of orthopaedics vol. 48,2 (2014): 197-202. doi:10.4103/0019-5413.128765
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Orthopaedics & Traumatology: Surgery & Research. 2010 Jun 1;96(4):400-6.
- ↑ 5.0 5.1 5.2 Lintz, Francois, et al. "Anterior Cruciate Ligament Mucoid Degeneration: a Review of the Literature and Management Guidelines." Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, vol. 19, no. 8, 2011, pp. 1326-33.
