J Knee Surg 2019; 32(06): 577-583
DOI: 10.1055/s-0038-1660514
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures

Andrew J. Hotchen
1   Division of Trauma and Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, United Kingdom
2   Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
,
Charis Demetriou
2   Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
,
Dennis Edwards
2   Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
,
Joel T. K. Melton
2   Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
› Author Affiliations
Funding None.
Further Information

Publication History

20 November 2017

05 May 2018

Publication Date:
13 June 2018 (online)

Abstract

The presentation and clinical course of mucoid degeneration of the anterior cruciate ligament (MD-ACL) are poorly documented within the literature. Subsequently, it is under-diagnosed and the optimal management strategy remains ill-defined. Here, we characterize the syndrome associated with MD-ACL and compare the natural clinical course with the outcomes of arthroscopic management. Thirty-one patients with radiological features of MD-ACL over a 2-year period had their clinical notes retrospectively reviewed. Seven patients underwent arthroscopic debridement of the ACL for MD. These were followed up for a minimum of 2 years and an average of 2.8 years from surgery. The remainder were managed conservatively (n = 24) and were followed up for a minimum of 2 years and an average of 4.0 years. The notch width index (NWI) and associated pathology was noted. Primary outcome measures were presence of knee pain and use of analgesia. Secondary outcome measures were the Oxford and Lysholm knee scores. The most commonly reported symptoms were posterior knee pain (77.4%) and limitation of terminal flexion (58.1%). All patients who underwent arthroscopic debridement were pain and analgesia free at follow-up. Of the patients who did not undergo arthroscopic surgery, three patients had knee replacement surgery and three were lost to follow-up. The remaining patients, 14/18 (77.8%), reported knee pain and regular analgesia use at follow-up, which was significantly more than the arthroscopic debridement group (p < 0.01). The knee scores were significantly better in the arthroscopic debridement group at follow-up (Oxford knee score: 45 vs 34; Lysholm: 92 vs 67; p < 0.01). Furthermore, the postoperative improvement in the Oxford knee and Lysholm scores compared with preoperatively was 12.1 and 31.8 points, respectively (p < 0.01). The NWI was increased in patients with mild-to-severe osteoarthritis (0.266 vs 0.273; p < 0.05). MD-ACL should be considered in patients who report posterior knee pain, limitation of terminal flexion, and it can be associated with other knee pathologies. MD-ACL can be successfully managed with arthroscopic radio frequency debulking with improvement in quality of life at follow-up.

Ethical Approval

Ethical approval was sought and granted by the local research and development committee in our hospital.


 
  • References

  • 1 Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid cystic degeneration of the cruciate ligament. J Bone Joint Surg Br 1999; 81 (02) 304-305
  • 2 Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C. Mucoid degeneration of the anterior cruciate ligament: management and outcome. Indian J Orthop 2014; 48 (02) 197-202
  • 3 Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Knee Surg Sports Traumatol Arthrosc 2011; 19 (08) 1326-1333
  • 4 Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Orthop Traumatol Surg Res 2010; 96 (04) 400-406
  • 5 McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Skeletal Radiol 2001; 30 (06) 312-315
  • 6 Morice A, Coupry A, Lintz F, Robert H. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Orthop Traumatol Surg Res 2013; 99 (06) 693-697
  • 7 Fernandes JL, Viana SL, Mendonça JLF. , et al. Mucoid degeneration of the anterior cruciate ligament: magnetic resonance imaging findings of an underdiagnosed entity. Acta Radiol 2008; 49 (01) 75-79
  • 8 Papadopoulou P. The celery stalk sign. Radiology 2007; 245 (03) 916-917
  • 9 Kwee RM, Ahlawat S, Kompel AJ. , et al. Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage. Osteoarthritis Cartilage 2015; 23 (09) 1543-1550
  • 10 Hasegawa A, Otsuki S, Pauli C. , et al. Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. Arthritis Rheum 2012; 64 (03) 696-704
  • 11 Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Am J Roentgenol 2004; 182 (05) 1283-1287
  • 12 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
  • 13 Souryal TO, Moore HA, Evans JP. Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med 1988; 16 (05) 449-454
  • 14 Hotchen AJ, Melton JTK. Radiofrequency ablation for mucoid degeneration of the anterior cruciate ligament. Arthrosc Tech 2018; 7 (05) e459-e463
  • 15 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; 198: 43-49
  • 16 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998; 80 (01) 63-69
  • 17 Bigoni M, Turati M, Sacerdote P. , et al. Characterization of synovial fluid cytokine profiles in chronic meniscal tear of the knee. J Orthop Res 2017; 35 (02) 340-346
  • 18 Abate M, Silbernagel KG, Siljeholm C. , et al. Pathogenesis of tendinopathies: inflammation or degeneration?. Arthritis Res Ther 2009; 11 (03) 235
  • 19 Melloni P, Valls R, Yuguero M, Sáez A. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle. Skeletal Radiol 2004; 33 (06) 359-362
  • 20 Al-Saeed O, Brown M, Athyal R, Sheikh M. Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2013; 21 (03) 678-682
  • 21 Domzalski M, Grzelak P, Gabos P. Risk factors for anterior cruciate ligament injury in skeletally immature patients: analysis of intercondylar notch width using magnetic resonance imaging. Int Orthop 2010; 34 (05) 703-707
  • 22 Chudasama CH, Chudasama VC, Prabhakar MM. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Indian J Orthop 2012; 46 (05) 561-565
  • 23 Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS. Mucoid degeneration of the anterior cruciate ligament: partial arthroscopic debridement and outcomes. J Arthrosc Jt Surg 2016; 3 (01) 28-33
  • 24 Tilley S, Thomas N. What knee scoring system?. J Bone Joint Surgery Br. Sept “Focus on” Series. Available as: http://www.boneandjoint.org.uk/content/focus/what-knee-scoring-system