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

Abstract

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.

Reconstruction Considerations Following Complete Excision of Mucoid-Degenerated Anterior Cruciate Ligament: A Retrospective Study

“…A wide array of treatments have been described in the current literature, ranging from partial to total excision of the ACL with or without notchplasty [ 2 , 5 , 6 , 8 , 9 , 12 , 22 , 24 , 25 ]. A conclusion drawn from a systematic review conducted by Vivekanantha et al suggests that most authors believe in a non-aggressive method of partial ACL debridement, as there has not been any report of recurrence, and the remaining fibers may prevent instability [ 11 ]. Notchplasty, along with partial debridement, was denounced by several authors, who believed that a thorough debridement of the bulky ACL would remove the impingement [ 8 , 19 ].…”

“…While the literature is replete with outcomes after partial ACL debridement, only a few authors have reported the clinical outcome after total ACL excision [ 6 , 9 , 12 , 25 ]. Nevertheless, the overall clinical outcome, sans instability, in the systematic review by Vivekanantha et al is comparable in the groups that underwent partial vs. total ACL excision [ 11 ].…”

“…Nevertheless, if it does not respond to conservative treatment, the current consensus in the literature for treating MD of ACL is arthroscopic debridement, partial or total [5][6][7][8][9]. While many authors advocate that debridement of mucinous tissue with partial ACL debulking is adequate without jeopardizing knee stability [7,8,10,11], a few authors have reported total excision of the ACL without any significant effect on functional knee stability [6,9,12]. Therefore, we aimed to investigate the post-operative functional outcomes and residual instability after the total excision of MD of ACL.…”