Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. 19. ACL ganglion cyst and ACL mucoid degeneration most often occur independently, but they may also coexist [5]. Unlike tears and ganglion cysts1 of the anterior cruciate ligament (ACL), mucoid degeneration is not a well-known entity. These are often of insidious onset, without any history of significant trauma, and they do not respond to conventional NSAIDs and physiotherapy. Sign In; Create an Account "Never doubt that a small group of thoughtful, committed citizens can change the world. Ganglion cysts are synovial cysts that are filled with gelatinous mucoid material and commonly encountered in orthopedic clinical practice. There was no recorded case of recurrence after partial resection in the literature. © Copyright 2017Vaishya et al. Vaishya R, Esin Issa A, Agarwal A, et al. Mucoid degeneration and ganglion cyst of the ACL are rare causes of knee pain. 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. The duration of symptoms is variable from weeks to months. Check for errors and try again. Unlike other large ACL ganglion cysts, it caused restriction to flexion of the knee instead of extension. Ganglion cyst and mucoid degeneration of the anterior cruciate ligament are the non-traumatic lesions that present with chronic knee pain and severe limitation in … Anterior cruciate ligament cyst, Computed tomography- guided aspiration of a ganglion cyst of anterior cruciate ligament: A case report, Anterior cruciate ligament ganglion cyst treated under computed tomography guided aspiration in a professional soccer player, Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage, Mucoid metaplastic-degeneration of anterior cruciate ligament, Symptomatic mucoid degeneration of the anterior cruciate ligament, Arthrocopic management of mucoid degeneration of anterior cruciate ligament, Mucoid degeneration of anterior cruciate ligament, Mucoid cystic degeneration of the cruciate ligament, Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament, Mucoid degeneration of anterior cruciate ligament: management and outcome, Anterior cruciate ligament degeneration: selecting the best treatment option, Mucoid degeneration of the anterior cruciate ligament: partial arthroscopic debridement and outcomes, Ligament signal stronger than joint fluid. Although the exact etiology of the development of ganglion cysts is unknown, they are believed to arise from repetitive microtrauma resulting in mucinous degeneration of connective tissue. [3] Along with tears and anterior cruciate ligament ganglion cysts, mucoid degeneration is a relatively common cause of increased signal within the ACL. The etiology of ACL ganglion cysts is uncertain. Pain and limitation in range of motion of the knee due to mucoid degeneration do not respond completely to NSAIDs and physiotherapy [35]. With the increasing awareness of ACL ganglion cyst, several cases have been reported in the literature in the recent past. The etiology is disputed, and there are multiple theories of its origin, two being most common: the degenerative theory and the synovial … ACL ganglia and mucoid degeneration can cause pain and decreased range of movement in the knee. Anterior cruciate ligament mucoid degeneration Anterior cruciate ligament complete tear … The relationship between ACL ganglion cysts and mucoid degeneration has been theorized, but its existence is still unproven. ACL mucoid degeneration coexists with ACL ganglion cyst, and there is a higher association of ACL mucoid degeneration with a meniscal tear, chondral damage, and intraosseous cyst at the femoral and tibial attachment of the ligament. The pathogenesis remains controversial, with two theories being favored: sequelae of ACL mucoid degeneration. A 48-year-old-male patient presented with kne … Mucoid degeneration of both ACL and PCL Clin Orthop Surg. Privacy Policy In mucoid degeneration of the cruciate ligaments the ligament fibers may be poorly defined on T1 and proton density-weighted images, but may be more apparent on T2-weighted imaging. pathogenesis of ACL mucoid degeneration is still unresolved, but injury, ganglion cyst, and the degenerative process leading to loss of the synovial lining of the ACL have been postulated [30]. 2012 … pathogenesis of ACL mucoid degeneration is still unresolved, but injury, ganglion cyst, and the degenerative process leading to loss of the synovial lining of the ACL have been postulated [30]. The other drawbacks of this method are the inability to address associated intra-articular pathologies. ACL ganglion cyst and ACL mucoid degeneration most often occur independently, but they may also coexist [5]. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. Superficial ganglion cyst in the wrist, foot, and knee are palpable and easily diagnosed clinically, but deeper ganglia such as intra-articular knee ganglia, suprascapular notch ganglia, and periacetabular ganglia are difficult to diagnose clinically as they are not palpable. Similarly, four of six patients (66%) with mucoid degeneration of the ACL exhibited associated intraosseous cysts in the present study. There are no fixed clusters of symptoms that are diagnostic of ACL ganglion cyst. [28]. [] found the incidence of mucoid degeneration in their study population to be 1.0%.Most of their reported cases were incidental findings without contributory symptoms. , The prevalence of mucoid degeneration of the ACL has been reported to be 0.43%. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament ... Esin Issa A, Agarwal AK, Vijay V. Anterior cruciate ligament ganglion cyst and mucoid degeneration: a review. By joining Cureus, you agree to our MD-ACL is thought to be part of a spectrum of ACL disease that can range from ganglion cysts to MD. Clinical examination may show limitation of motion, joint line tenderness [34], joint effusion, and a positive grinding test of the meniscus. Although the term ganglion cyst is widely accepted, it needs to be differentiated from synovial cysts and mucoid degeneration. Lintz F. Pujol N. Dejour D. Boisrenoult P. Beaufils P. Anterior cruciate ligament mucoid degeneration: Selecting the best treatment option. There are no discrete cystic areas in mucoid degeneration, which should help to separate it from the more defined ganglion cyst . : Hensen JJ, Coerkamp EG, Bloem JJ, et al.. Mucoid degeneration of the ACL is a very rare cause of knee pain. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. SIQ™ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. Bergin et al. Methods: Retrospective analysis of clinical data of patients with ganglion cysts of ACL and PCL as confirmed by arthroscopy and pathology. 3. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. MRI is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint. [3] The absence of clinical signs and symptoms consistent with instability also helps to avoid misdiagnosis. The gold standard investigation for diagnosing an ACL ganglion cyst and mucoid degeneration is MRI [8-9]. Its pathogenesis has been attributed to myxoid degeneration of the connective tissue. … These lesions are predominantly incidental findings on MR imaging and arthroscopy. If this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings. Indeed, it is the only thing that ever has." These findings lend credence to the theory that anterior cruciate ligament ganglia may be part of a degenerative process and that these two entities may represent different manifestations of this continuum. Mechanical locking, clicking sensation, and stiffness also occur frequently. Computed tomography scan guided aspiration is also useful in selected cases of ACL ganglion cyst. After a database search of 4,221 knee MRI examinations, Bergin et al. ACL mucoid degeneration has been mistakenly reported as ACL rupture on MRI. The exact pathogenesis of ACL ganglion cyst is still controversial. doi:10.7759/cureus.1682. However, recent publications have suggested that it might be underdiagnosed or misdiagnosed, and that the adverse effects of treatment by ACL resection might be underestimated. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Anterior cruciate ligament (ACL) mucoid degeneration, along with tears and anterior cruciate ligament ganglion cysts, is a relatively common cause of increased signal within the anterior cruciate ligament (ACL ). Sex ratio was 1.28 females (F) to 1 male (M) according to Salvati, et al., contrary to Cha, et al. ACL mucoid degeneration has been mistakenly reported as ACL rupture on MRI. A ganglion cyst that is located anteriorly at the tibial attachment results in extension block while those located posteriorly produce flexion block [19-20]. They present as a variable duration of symptoms from weeks-to-months and sometimes years [18]. Learn more here. : Pedrinell B, Castellana FB, Fontes RB, et al. CONCLUSION: Mucoid degeneration and ganglion cyst involving PCL are uncommon lesions and represents the spectrum of same pathology. Ganglion cyst and mucoid degeneration of the anterior cruciate ligament are the non-traumatic lesions that present with chronic knee pain and severe limitation in terminal range of motion of the knee. ACL mucoid degeneration and ganglia, commonly coexist on MRI, both have a high association with intraosseous cysts and are typically not associated with ligament instability (secondary signs of ACL injury are usually absent) . This link will take you to a third party website that is not affiliated with Cureus, Inc. High ratings should be reserved for work that is truly groundbreaking in its respective field. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts at the femoral and tibial attachments. ACL and PCL ganglion.A man in his 40s. The pain may limit the terminal movements of the knee. Arthroscopy affords complete excision of the cyst, along with diagnosis and treatment of other associated intra-articular knee derangements. Read our Reviewer Guide for more info. anterior cruciate ligament ganglion cyst, mucoid degeneration, Raju Vaishya, Abdulrazaq Esin Issa, Amit Kumar Agarwal , Vipul Vijay, Published: Ganglion cyst and mucoid degeneration of the anterior cruciate ligament are the non-traumatic lesions that present with chronic knee pain and severe limitation in … Percutaneous aspiration of cruciate ligament ganglion cysts has both diagnostic and therapeutic value. Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The clinical presentation is one of posterior pain with limited flexion. Ganglion cysts of the anterior cruciate ligament: a … We reviewed previous reports and summarized clinical features and symptoms, including those found in our two cases. (September 13, 2017) Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Excellent results have been reported following arthroscopic treatment with complete resolution of symptoms [10].The purpose of this review article is to provide an overview of the diagnosis and treatment of ACL ganglion cyst and ACL mucoid degeneration. No recurrence of symptoms or cyst on MRI post-arthroscopic excision has been reported in the literature; the longest follow-up was five years. These clinical features, however, are not pathognomonic for ACL mucoid degeneration, as they are common presentations of internal knee derangement; however, they should raise suspicion and the need for further evaluation with MRI (especially if the symptoms are nonspecific and unresponsive to non-steroidal anti-inflammatory drugs and physiotherapy). Mucoid degeneration of the ACL is a very rare cause of knee pain. It is a reasonable therapeutic option which is technically successful, associated with low complication rates and short hospitalization period allowing an immediate return to activities. Please note that Cureus is not responsible for any content or activities contained within our partner or affiliate websites. There is usually no antecedent history of significant trauma, and when present, it is normally trivial. These are often discovered incidentally on magnetic resonance imaging (MRI) of the knee or knee arthroscopy while evaluating symptoms of knee pain and limitation of knee motion. 1. Mucoid degeneration may coexist with ACL ganglia, as well as with intra-osseous cysts at the femoral and tibial attachments, most commonly at the tibial insertion . These symptoms are mostly of spontaneous onset without a history of trauma. , Further relationships with intra-osseous bone formation are not explained in the literature. The most common presentation is chronic knee pain of insidious onset, worsened by extreme knee movements. ADVERTISEMENT: Supporters see fewer/no ads. McIntyre et al.4) described this lesion of ACL Fig. Unlike ACL ganglion cyst, where CT scan and ultrasound-guided cyst aspiration is an effective treatment option, the interstitial nature of mucoid degeneration precludes this method. Mucoid degeneration and ganglion cyst are two distinct non-traumatic lesions of the anterior cruciate ligament (ACL) that most commonly occur discretely but occasionally coexist. (see history), Cite this article as: Sagittal images of anterior (A, B) and posterior (C, D) cruciate ligaments on magnetic resonance imaging show inhomogeneous intensity and hypertrophy (T1-weighted [A, C] and T2-weighted [B, D], respectively). The pathogenesis of these two lesions remained controversial but suggested theories include synovial tissue herniation, post-traumatic mucoid degeneration, ectopic synovial tissue theory, and mucoid degeneration of connective tissue [6-7]. Locking and grinding sensations may be present. The ACL mucoid degeneration and ganglion cysts are often co-existing MRI findings. It is sensitive, specific, noninvasive, and useful in planning operative treatment. This article describes 5 cases of mucoid degeneration of the ACL with clinical features, magnetic resonance imaging (MRI) findings, and a method of arthroscopic management of these cases. The MRI features suggestive of ACL mucoid degeneration are (a) abnormally thickened and an ill-defined, bulky ACL, (b) increased intra-ligamentous signals (intermediate signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and proton density weighted images) on all sequences interspersed among visible intact fibers (the celery stalk appearance), and (c) maintenance of normal orientation and continuity of the ACL (Figure 5). Keywords: mucoid degeneration; anterior cruciate ligament; notchplasty; ganglion cyst; posterior septal portal 1. Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. Orthop Traumatol Surg Res. It was reported to produce instant relief of pain and improvement in range of motion. Remote ligamentous trauma and mucoid degeneration play a role in the development of the cysts. They … They comprise mucoid material surrounded by a pseudocapsule 6. Mucoid degeneration of the ACL is a rare cause of knee Fig. Abstract; Full Text; Full Text PDF; PubMed; Scopus (19) Google Scholar; MD-ACL can either be … [29] reported a higher median age of 51 years (range: 35 - 75 years) in their review of 66 patients. They are relatively uncommon, and their exact aetiopathogenesis is still not clear. • It is possible that ganglion cysts are a byproduct of mucoid degeneration of the connective tissue or a … Aggressive total resection of the entire lesion is not supported in the literature. The Lachman test, anterior drawer test, and pivot shift test for ACL integrity are usually negative. Treatment modalities for ACL ganglion cyst include arthroscopic excision or puncture, CT scan, and ultrasound-guided aspiration [25-26]. Anterior cruciate ligament (ACL) ganglion cyst and ACL mucoid degeneration are two non-traumatic pathologies that have been increasingly found be associated with insidious onset chronic knee pain. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Magnetic resonance imaging is the investigation of choice, and diagnostic criteria are defined. Mucoid degeneration and ganglion cyst of the ACL are rare causes of knee pain. Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review, Fluid signal in the substance of the ligament with at least two of the three following criteria, ACL fibers intact and uninterrupted from tibial to femoral insertion, Ligament fibers poorly seen on T1-weighted images, Mass effect on anterior cruciate better ligament fibers, Possibly associated with joint effusion or bony cysts, Ligament bundles and fibers seen on T2-weighted images, Reversal of Acute Lead Encephalopathy in a Child. The reported incidence of intra-articular ganglia cyst of the knee ranged from 0.20% - 1.33% on knee MRI and 0.6% - 2.0% on knee arthroscopy [11-12]. The clinical presentation is one of posterior pain with limited flexion. Although sample … Kindly put your suggestions in comments,will come up with many more videos further . On arthroscopy, the ACL mucoid cyst is viewed as homogenous and hypertrophied with increased diameter, intact and competent fibers with normal orientation, loss of shining synovial lining, the absence of ligamentous mucosa, and the flow of a yellow mucoid substance upon probing [36] (Figure 6). This is a ganglion cyst. This ligament consists of two fibers, mainly, the anterio-medial and postero-lateral fibers, respectively. Almost 62% of them are located on the ACL. It is a reasonable therapeutic option which is technically successful, associated with low complication rates and short hospitalization period allowing an immediate return to activities. Most commonly mucoid degeneration and ganglion cyst involves ACL than PCL. The ACL stability tests, such as the anterior drawer test, Lachman test, and pivot shift tests, are negative. A ganglion is a cyst containing a mucin rich fluid bounded by pseudomembrane and are usually associated with a joint or tendon sheath. However, there are concerns about the possibility of recurrence since it is impossible to completely excise the sac of the cyst, although no recurrence has been reported. They have a tendency to extend into surrounding intra-articular or osseous structures. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Fig. This lesion of the ACL was first reported by Kumar et al [] in 1999.Since their report, there have been only some cases of mucoid degeneration of the ACL reported in the English literature [].In each of these reports, a mass-like structure displaced either the ACL or the PCL. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Indeed, it is the only thing that ever has.". Anterior cruciate ligament mucoid degeneration with ganglion cyst Its pathophysiology remains unclear. The etiology of both ganglion cysts and mucoid degeneration is unknown. doi:10.7759/cureus.1682, Received by Cureus: July 24, 2017 coid degeneration of the PCL as well as the ACL. ACL mucoid degeneration coexists with ACL ganglion cyst, and there is a higher association of ACL mucoid degeneration with a meniscal tear, chondral damage, and intraosseous cyst at the femoral and tibial attachment of the ligament. 3. The ACL has to be intact from tibial to femoral insertion to exclude partial or complete ACL rupture (Table 1). "Never doubt that a small group of thoughtful, committed citizens can change the world. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Arthroscopic treatment consists of debridement and partial resection of the afflicted portion of the ACL, leaving intact the remnant of the anteromedial and posterolateral border and intact tibial and femoral attachment without impingement on the roof or lateral wall of the notch [37]. Purpose: Mucoid degeneration of the anterior cruciate ligament (ACL) is not a well-known entity. As a point of reference, Bergin et al. (2012) American Journal of Roentgenology. A final cystic lesion consideration includes popliteal cyst, but this … (Authors cannot rate their own articles.). Published: September 13, 2017. (a) Coronal T2*WI, (b) axial T2*WI, and (c) arthroscopic image.There is a cystic lesion (arrow) sandwiched between ACL (A) and PCL (P), both of which are compressed by this lesion.Arthroscopic puncture of the cystic lesions revealed it was filled with yellow jellylike material BACKGROUND: Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). The mean age of patients with discrete ACL ganglion has been quoted as 39 years old (age range of 19-60) [13], although isolated cases in children ages two years old [13-14], nine years old [15], and 12 years old [16] have been reported in the literature. Partial resection of the ACL results in immediate relief of pain and improvement in range of motion. reported that the incidence of ACL mucoid degeneration is 1.0% (44/4221) compare with incidence of PCL mucoid degeneration in reference was 0.1% (14/12972) [8]. in 1999 [].It is a chronic degenerative change of a bulky ACL that may lead to notch impingement syndrome in the absence of instability symptoms and significant trauma history [1,2,3,4].Symptoms include insidious onset of posterior knee pain and limited range of motion (ROM) []. This infiltrating lesion is included in the mucoid pathology of the intercondylar fossa. Pain and limitation in range of motion have been attributed to both increased volume and tension within the ligament and mechanical impingement with unique function of the ACL in providing nociceptive sensory signals [33]. Maikano A, Pascual-Garrido C, Rolon A, et al. Share this article with your colleagues. Peer review began: August 15, 2017 Diane Bergin, William B. Morrison, John A. Carrino, Samridhi N. Nallamshetty, Arthur R. Bartolozzi. Criteria for anterior cruciate ligament ganglia were fluid signal in the substance of the ligament having at least two of the following three criteria: mass effect on anterior cruciate ligament fibers, lobulated margins, and anterior cruciate ligament fluid disproportionate to joint fluid. Mucoid degeneration of the ACL and ganglion cyst formation may share the same pathology secondary to a mucinous degenerative change in the connective tissue, perhaps even as a precursor to a complete tear [1, 7].
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