Clinical Outcomes of Arthroscopic Notchplasty and Partial Resection for Mucoid Degeneration of the Anterior Cruciate Ligament

Abstract

Background: Mucoid degeneration of the anterior cruciate ligament (MD-ACL) is a chronic degenerative process involving a hypertrophied ACL, which may lead to notch impingement syndrome. As a treatment method, there is consensus regarding arthroscopic resection for MD-ACL resulting in good clinical outcomes; however, additional notchplasty remains controversial. The purpose of this study was to investigate clinical outcomes after arthroscopic partial resection of the ACL and additional notchplasty performed to minimize volume reduction of the ACL. Study Design: Level IIIb retrospective cohort study. Methods: Of 1810 individuals who underwent knee arthroscopic surgery performed by the same surgeon between July 2011 and October 2020, 52 were included, while 10 were excluded due to a follow-up period of <1 year. Clinical data including pain location, terminal flexion or extension pain, range of motion (ROM), Lysholm knee score, and Hospital for Special Surgery (HSS) knee score were assessed pre- and postoperatively. Additionally, according to the resected volume of the ACL, patients were classified into two groups: <25% (Group 1), and 25–50% (Group 2). Clinical outcomes were compared between the two groups. Results: There were 17 (40.5%) men and 25 (59.5%) women with a mean age of 53.9 years (range, 16–81 years) at the time of surgery. The mean duration of symptoms before surgery was 14.4 months (range, 3–66 months). Arthroscopic partial resection of the MD-ACL was performed in all patients, and concomitant notchplasty was performed in 36 (81.8%). All clinical scores improved postoperatively, and were statistically significant (p < 0.01). However, there was no significant difference in clinical outcomes between groups 1 and 2 classified according to the resected ACL volume. Recurrence of MD-ACL was recorded in only one patient, 11 months after arthroscopic treatment. No patients underwent ACL reconstruction because of symptoms of anterior instability. Conclusion: Arthroscopic partial resection of the ACL and concomitant notchplasty yielded satisfactory outcomes for the treatment of MD-ACL. Notchplasty may be an alternative procedure to avoid total ACL resection and postoperative instability.

Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study

“…This was confirmed at 2 years 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: 96.385° ± 5.78°; mean post-operative: 117.89° ± 2.64°) as compared with 5.02° in group A (mean pre-operative: 98.093 ± 4.79°; mean post-operative: 103.11° ± 4.1°). Although a few studies such as the one by Lee et al [7] have documented the presence of flexion contracture, we did not notice the same in any patient from the recruited sample size. The follow-up period was similar to that of Cha et al [5] and Chudasama et al [21].…”

“…Although a few studies such as the one by Lee et al. [ 7 ] have documented the presence of flexion contracture, we did not notice the same in any patient from the recruited sample size. The follow-up period was similar to that of Cha et al.…”

“…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]. This was postulated to be due to the increased tension caused by the mucinous deposition in the substance of the ACL, leading to irritation of the native nociceptors of the tendon and the consequent impingement on the lateral femoral condyle, femoral notch and posterior cruciate ligament (PCL) owing to the increased thickness of the ACL [6][7][8]. MRI has been established as the gold standard imaging modality for the diagnosis of MD-ACL based on the criteria laid out by Bergin et al [2].…”

Partial debridement is the most commonly reported treatment option for mucoid degeneration of the anterior cruciate ligament: a systematic review

“…Five studies used only a motorized shaver to perform partial debridement [5, 13, 20, 26, 27]. One of these studies compared a motorized shaver less than 25%, and from 25 to 50% [20]. Two studies used a combination of a motorized shaver and radiofrequency ablation (RFA) [9, 26].…”

“…Three studies defined partial debridement as shaving < 50% thickness of the ACL, but seven studies did not have a specific definition for partial debridement [5, 20, 22]. Five studies used only a motorized shaver to perform partial debridement [5, 13, 20, 26, 27]. One of these studies compared a motorized shaver less than 25%, and from 25 to 50% [20].…”