Management of mucoid degeneration of the anterior cruciate ligament: a systematic review

Sweed, Tamer Ahmed; Mussa, Mohamed; El‐Bakoury, Ahmed; Geutjens, Guido; Metcalfe, Andrew

doi:10.1186/s43019-021-00110-6

Cited by 11 publications

(16 citation statements)

References 19 publications

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“…Corroborating these findings were the improvements and the final PROMs of both the groups which corresponded with the findings of the literature review by Sweed et al on nine studies [8]. While both the groups showed improvements in the functional scores post-surgery, which could be attributed to the UKA primarily, the finding that patients in whom debulking was done had better mean IKDC and mean KSS at 2 years follow-up confirmed the study hypothesis that debulking improves the long-term outcome in patients with MD-ACL undergoing UKA.…”

Section: Discussionsupporting

confidence: 88%

“…This study showed that the patients who underwent debulking had statistically superior knee function, lesser rest pain and greater satisfaction rates at 2 years of follow-up compared with those in whom MD-ACL was not debulked. Various techniques have been proposed for the debulking of MD-ACL including arthroscopic debridement using shaver or radiofrequency ablation, with or without notchplasty, that have shown to give good clinical results [ 8 , 19 ]. The demographic distribution of study population with respect to the mean age, gender distribution and the side affected was similar to the recent studies done on the MD-ACL as a standalone entity [ 2 , 3 , 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Various techniques have been proposed for the debulking of MD-ACL including arthroscopic debridement using shaver or radiofrequency ablation, with or without notchplasty, that have shown to give good clinical results [ 8 , 19 ]. The demographic distribution of study population with respect to the mean age, gender distribution and the side affected was similar to the recent studies done on the MD-ACL as a standalone entity [ 2 , 3 , 5 , 8 ]. A few studies have shown direct correlation between the presence of meniscus tear in patients with MD-ACL.…”

Section: Discussionmentioning

confidence: 99%

“…MD-ACL lies in the grey area of a stable, yet functionally limiting condition that has the propensity to become relatively unstable after undergoing debulking. Despite recent developments suggesting that debulking of MD-ACL does not cause instability [ 8 ], the involvement of another surgery that can directly be impacted by it complicates the decision making. When considering a UKA in such a patient, a plethora of dilemmas may arise in the mind of an orthopaedic surgeon vis a vis preserving the MD-ACL at the cost of functional limitation, or debulking it and predisposing the UKA to failure owing to instability.…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Rajani

Shah

Mittal

et al. 2022

Knee Surg & Relat Res

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Background Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). Methods Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. 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. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2 years follow-up. Results A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2 years 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. Conclusions Debulking of mucoid ACL in patients undergoing unicompartmental knee arthroplasty significantly reduces the rest pain and improves the final range of motion of the knee joint, subsequently improving the overall functional and clinical outcome of the patient and resulting in greater patient satisfaction.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Rajani

Shah

Mittal

et al. 2022

Knee Surg & Relat Res

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

Vivekanantha

Diao

Kay

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To determine clinical outcomes and risks of various management strategies for mucoid degeneration of the anterior cruciate ligament (MD-ACL). Methods Three databases MEDLINE, PubMed and EMBASE were searched from inception to January 29th, 2023 for literature outlining clinical outcomes for various management strategies of MD-ACL. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on satisfaction scores, visual analogue scale (VAS) scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, Knee Osteoarthritis and Outcome Scores (KOOS), range of motion and Lachman test were recorded. Results A total of 14 studies comprising 776 patients (782 knees) were included in this review. Partial debridement was reported in ten (71.4%) studies comprising 446 patients, showing signiicant improvements in VAS, Lysholm, IKDC scores and range of motion. Complete debridement was reported by two (14.2%) studies comprising 250 patients, and resulted in increases in Lysholm scores, KOOS, and range of motion. Reduction plasty was reported in two (14.2%) studies comprising 26 patients and showed improvements in VAS and Lysholm scores, and range of motion. Other methods of treatment included conservative management and ultrasound decompression. Complete debridement resulted in 10/23 (43%) patients with a positive Lachman test. This was followed by reduction plasty and partial debridement, with 5/26 (19.2%) and 45/340 (13.2%) patients respectively having positive Lachman or elevated knee arthrometer scores. Pivot shifting was only reported in studies on partial debridement and reduction plasty, with 14/93 (15.1%) and 1/21 (4.8%) patients have positive results, respectively. Conclusion The most commonly reported management strategy for MD-ACL is partial debridement with complete debridement, reduction plasty and conservative management as alternative options. Current operative management strategies place individuals at risk for ACL insuiciency. Information from this review can aid surgeons and clinicians in understanding what treatment options are best for this patient population, by understanding the reported clinical beneits and risks of each strategy. Level of evidence IV.

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Association of tibial slope alterations with anterior cruciate ligament (ACL) injury and mucoid degeneration

Ravi,

Rehman,

Xia

et al. 2024

Skeletal Radiol

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Management of mucoid degeneration of the anterior cruciate ligament: a systematic review

Cited by 11 publications

References 19 publications

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

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

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

Association of tibial slope alterations with anterior cruciate ligament (ACL) injury and mucoid degeneration

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