Posts

Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 38-43 | Sujit Korday , Pushkar Khandekar , Suhail Kantawala , Nicholas Antao

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.658

Submitted Date: 01 Nov 2024, Review Date: 10 Nov 2024, Accepted Date: 28 Nov 2024 & Published Date: 10 Dec 2024


Author: Sujit Korday  [1], Pushkar Khandekar [1], Suhail Kantawala [2], Nicholas Antao [2]

[1] Department of Orthopedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
[2] Department of Orthopedics,Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Pushkar Khandekar,
Department of Orthopaedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
E-mail: drpushkarkhandekar@gmail.com


Abstract

Mucoid degeneration of the anterior cruciate ligament (MD-ACL), once thought to be a rare entity, is seen not so uncommonly in present day orthopaedic practice. Several hypotheses attempt to explain this entity. Clinically, it presents as knee pain with limitation of flexion or extension. There is no specific test available to clinically diagnose MD-ACL. Magnetic Resonance Imaging (MRI) remains the imaging modality of choice to diagnose MD-ACL. Therefore, a high index of suspicion is necessary to be able to diagnose this condition. This article reviews the available literature about the etio-pathological aspects of MD-ACL, its clinical features, radiological and arthroscopic findings, as well as various treatment modalities available.
Keywords: Mucoid degeneration, anterior cruciate ligament, knee, arthroscopy, MRI.


References

1. Nicolas Himpe, Pieter Berger, Hilde Vandenneucker. Mucoid degeneration of the anterior cruciate ligament. Complete resection as equivalent treatment to partial resection. Acta Orthop Belg. 2020;86(2):272–9.
2. Scranton PE Jr F EL. Mucoid degeneration of the patellar ligament in athletes. . J Bone Joint Surg Am. 1992 Mar;74(3):435–7.
3. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid cystic degeneration of the cruciate ligament. Clinical J Bone Joint Surg [Br]. 1999.
4. Pandey V, Suman C, Sharma S, Rao S, Kiran Acharya K, Sambaji C. Mucoid degeneration of the anterior cruciate ligament: Management and outcome. Indian J Orthop. 2014 Mar;48(2):197–202.
5. Makino A, Pascual-Garrido C, Rolón A, Isola M, Muscolo DL. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Knee Surgery, Sports Traumatology, Arthroscopy. 2011 Mar 1;19(3):408–11.
6. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. Vol. 32, Journal of Knee Surgery. Georg Thieme Verlag; 2019. p. 577–83.
7. Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS. Mucoid degeneration of the anterior cruciate ligament: Partial arthroscopic debridement and outcomes. Journal of Arthroscopy and Joint Surgery. 2016 Jan;3(1):28–33.
8. Fernandes JL, Viana SL, Mendonça JLF, Freitas FMO, Bezerra ASA, Lima GAS, et al. Mucoid degeneration of the anterior cruciate ligament: magnetic resonance imaging findings of an underdiagnosed entity. Acta radiol. 2008 Feb 1;49(1):75–9.
9. Mcintyre J, Moelleken S, Tirman P. A RT I C L E Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Vol. 30, Skeletal Radiol. 2001.
10. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin S Il. Arthroscopic Treatment of Mucoid Hypertrophy of the Anterior Cruciate Ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2008 Jun;24(6):642–9.
11. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR, Bergin D. Anterior Cruciate Ligament Ganglia and Mucoid Degeneration: Coexistence and Clinical Correlation [Internet]. Vol. 182, AJR. 2004. Available from: www.ajronline.org
12. Salvati F RFLNPMBAMC. Mucoid metaplastic-degeneration of anterior cruciate ligament . J Sports Med Phys Fitness. 2008 Dec;48(4):483-7.
13. Cho S Do, Youm YS, Lee CC, Seo DK, Kim TW. Mucoid degeneration of both ACL and PCL. Clin Orthop Surg. 2012;4(2):167–70.
14. Hotchen AJ, Melton JTK. Radiofrequency Ablation for Mucoid Degeneration of the Anterior Cruciate Ligament. Arthrosc Tech. 2018 May 1;7(5):e459–63.
15. DJ DrR, SH DrA. Correlation of notch width index in knees with mucoid degeneration of anterior cruciate ligament to normal knees. International Journal of Orthopaedics Sciences. 2021 Jul 1;7(3):368–72.
16. Napoli A, Wulf MI, Bruno CH. Case 10672 Anterior cruciate ligament mucoid degeneration: MR findings. 2013;
17. Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, et al. Association of mucoid degeneration of the anterior cruciate ligament at MR imaging with medial tibiofemoral osteoarthritis progression at radiography: Data from the osteoarthritis initiative. Vol. 287, Radiology. Radiological Society of North America Inc.; 2018. p. 912–21.
18. Vaishya R, Esin Issa A, Agarwal AK, Vijay V. Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review. Cureus. 2017 Sep 13;
19. Lee JW, Ahn JT, Gwak HG, Lee SH. Clinical outcomes of arthroscopic notchplasty and partial resection for mucoid degeneration of the anterior cruciate ligament. J Clin Med. 2021 Jan 2;10(2):1–9.
20. Loganathan DrD, Sundar S DrS, Sundar DrS, Sahanand DrS, Rajan DrD V. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. International Journal of Orthopaedics Sciences. 2018 Oct 1;4(4):875–80.
21. Lancaster TF, Kirby AB, Beall DP, Wolff JD, Wu DH. Mucoid degeneration of the anterior cruciate ligament: a case report. J Okla State Med Assoc. 2004;97(8):326–8.
22. Saravanan P, Sundararajan T. Management of mucoid degeneration of anterior cruciate ligament. Int J Orthop. 2018;8(2):36.
23. Amiel D, Billings E, Harwood FL. Collagenase activity in anterior cruciate ligament: protective role of the synovial sheath [Internet]. 1990. Available from: www.physiology.org/journal/jappl
24. Pande S, Kushwah AP. S, Nelson SS, Saxena A, Kumar S. MUCOID DEGENERATION OF THE ANTERIOR CRUCIATE LIGAMENT : A CASE REPORT. J Evol Med Dent Sci. 2015 Jun 1;4(44):7689–91.
25. J.J. Hensen, E.G. Coerkamp, J.L. Bloem, A.M. De Schepper. Mucoid degeneration of the anterior cruciate ligament JBR-BTR [Internet]. 2007. Available from: https://www.researchgate.net/publication/6143682
26. Solís GS, Waghchoure C, Vinagre G. Symptomatic ACL mucoid degeneration in middle-age athletes. Vol. 31, Journal of Orthopaedics. Reed Elsevier India Pvt. Ltd.; 2022. p. 67–71.
27. Jung KH, Cho S Do, Park KB, Youm YS. Relation between mucoid degeneration of the anterior cruciate ligament and posterior tibial slope. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2012 Apr;28(4):502–6.
28. Youm YS, Cho S Do, Cho HY, Jung SH. Relationship between mucoid degeneration of the anterior cruciate ligament and posterior tibial slope in patients with total knee arthroplasty. Knee Surg Relat Res. 2016 Mar 1;28(1):34–8.
29. Cha JH, Lee SH, Shin MJ, Choi BK, Bin S Il. Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation. Skeletal Radiol. 2008 Sep;37(9):821–6.
30. Fealy S, Kenter K, Dines JS, Warren RF. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2001;17(9):1–4.
31. Nelissen RGHH. Retain or sacrifice the posterior cruciate ligament in total knee arthroplasty? A histopathological study of the cruciate ligament in osteoarthritic and rheumatoid disease. J Clin Pathol. 2001 May 1;54(5):381–4.
32. Boisrenoult P, Lintz F, Dejour D, Pujol N, Beaufils P. Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament: Medium Term Follow-Up Results About 29 Cases. Journal of Bone & Joint Surgery, British Volume. 2011;93-B(SUPP II).
33. 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. Orthopaedics and Traumatology: Surgery and Research. 2013 Oct;99(6):693–7.
34. Ventura D, Nuñez JH, Joshi-Jubert N, Castellet E, Minguell J. Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. CiOS Clinics in Orthopedic Surgery. 2018 Sep 1;10(3):307–14.
35. Choubey R, Jain A. Mucoid Degeneration of the Anterior Cruciate Ligament: A Case Report and Review of Literature. J Orthop Case Rep [Internet]. 5(3):87–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27299081
36. Celikyay F, Yuksekkaya R, Bilgic E. A retrospective comparison of ACL tear and mucoid degeneration MRI findings and an emphasis on evaluating of ACL, Blumensaat, and PCL Angles. J Belg Soc Radiol. 2020;104(1).
37. Chudasama CH, Chudasama VC, Prabhakar MM. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Indian J Orthop. 2012 Sep;46(5):561–5.
38. Narvekar A, Gajjar S. Mucoid Degeneration of the Anterior Cruciate Ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2004;20(2):141–6.
39. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: Selecting the best treatment option. Orthopaedics and Traumatology: Surgery and Research. 2010 Jun;96(4):400–6.
40. Kusano M, Horibe S, Tanaka Y, Yonetani Y, Kanamoto T, Shiozaki Y, et al. Early reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the anterior cruciate ligament. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015 Jul;2(3):95–7.
41. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Skeletal Radiol. 2021 Sep 1;50(9):1837–43.
42. Shelly MJ, Dheer S, Kavanagh EC. Metastatic adenocarcinoma of the lung mimicking mucoid degeneration of the anterior cruciate ligament. Ir J Med Sci. 2010 Jun;179(2):309–11.
43. El Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: A case report. Pan African Medical Journal. 2013 Jun 20;15.
44. Choukimath SK, Kodi H, Nedumparampil MM, Pilar A, Pruthviraj PA, Krishnan R, et al. Mucoid Degeneration of Anterior Cruciate Ligament—A Systematic Approach for Debulking. Arthrosc Tech. 2024;
45. Pimprikar M V., Patil HG. Anterior Cruciate Ligament Ganglion and Decompression of Mucoid Degeneration Using a “Figure-of-4 Position.” Arthrosc Tech. 2024;
46. Hensen JJ CEBJDSA. Mucoid degeneration of the anterior cruciate ligament. Journal of Belgian Society of Radiology. 2007 May;90(3):192–3.
47. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Knee Surg Relat Res. 2021 Dec 1;33(1).


How to Cite this article: Korday S, Khandekar P, Kantawala S, Antao N. Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature. Journal of Clinical Orthopaedics July-December 2024;9(2):38-43.

 (Article Text HTML)       (Download PDF)


Habitual Dislocation of the Patella Managed by a Two-in-One Procedure

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 63-66 | Ravi Mittal, M L V Sai Krishna

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.668

Submitted Date: 13 Jul 2024, Review Date: 18 Aug 2024, Accepted Date: 15 Sep 2024 & Published Date: 10 Dec 2024


Author: Ravi Mittal [1], M L V Sai Krishna [2]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,
[2] Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India

Address of Correspondence

M L V Sai Krishna,
Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India.
E-mail: krishna.mlv.sai@gmail.com


Abstract

Introduction: Habitual dislocation of the patella is a complex pathological condition of the patella which is characterized by lateral dislocation of the patella with flexion and relocation of the same with extension of the knee. There are numerous surgical procedures with various modifications that have been described in the literature based on the origin of pathology (soft tissue or bone). In this case series of 15 children, we described our technique of two-in-one procedure.
Materials and Methods: We included 15 patients with habitual dislocation of the patella between the ages of 5 and 9 years. In all the patients a detailed evaluation was done preoperatively and all of them were managed by a two-in-one procedure and followed up at 3 months and 1 year.
Results: There was no recurrence of dislocation in any of the patients and all the patients had attained their full range of movement by 1 year.
Conclusion: The two-in-one procedure is a simple and reproducible procedure for the treatment of habitual dislocation of the patella without any bony involvement. The procedure included graded lateral soft-tissue release and the Roux Goldthwait procedure. The amount of lateral soft-tissue release required is titrated intraoperatively.
Keywords: Habitual dislocation, Patella, Two in procedure, Knee.


References

1. Eilert RE. Congenital dislocation of the patella. Clin Orthop Relat Res 2001;389:22-9.
2. Bergmann NR, Williams PF. Habitual dislocation of the patella in flexion. J Bone Joint Surg Br 1988;70B:415-9.
3. Joo SY, Park KB, Kim BR, Park HW, Kim HW. The “four-in-one” procedure for habitual dislocation of the patella in children: Early results in patients with severe generalised ligamentous laxity and aplasis of the trochlear groove. J Bone Joint Sur Br 2007;89:1645-9.
4. Goldthwait JE. Slipping or recurrent dislocation of the patella: With the report of eleven cases. American Journal of Orthopedic Surgery, Vol. 1, pp. 293-308, 1903. J Bone Joint Surg 2003;85-A:2489.
5. Bakshi DP. Pes anserinus transposition for patellar dislocation. Long term follow up results. J Bone Joint Surg Br 1993;75B:305-10.
6. Gao GX, Lee EH, Bose K. Surgical management of congenital and habitual dislocation of the patellar. J Pediatr Orthop 1990;10:255-60.
7. Lai KA, Shen WJ, Lin CJ, Lin YT, Chen CY, Chang KC. Vastus lateralis fibrosis in habitual patella dislocation: An MRI study in 28 patients. Acta Orthop Scand 2000;71:394-8.
8. Niedzielski KR, Malecki K, Flont P, Fabis J. The results of an extensive soft-tissue procedure in the treatment of obligatory patellar dislocation in children with ligamentous laxity: A post-operative isokinetic study. Bone Joint J 2015;97-B:129-33.
9. Mittal R, Sitender, Jain S, Shukla A. Habitual patellar dislocation-management by two in one procedure, short term results. Indian J Orthop 2020;55:392-6.

How to Cite this article: Mittal R, Sai Krishna MLV. Habitual Dislocation of the Patella Managed by a Two-in-One Procedure. Journal of Clinical Orthopaedics 2024:July-December:9(2)63-66.

 (Article Text HTML)       (Download PDF)


Non Standard Deviation – Managing angular deformities around the knee in young age

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 32-37 | Binoti Sheth

DOI: 10.13107/jcorth.2023.v08i01.559


Author: Binoti Sheth [1]

[1] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.

Address of Correspondence
Dr. Binoti Sheth, MS, DNB, FCPS, D. Orth.
Professor and Head of Unit, Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General
Hospital, Sion, Mumbai, India.
E-mail: binotisheth@yahoo.com


Abstract

Angular deformities around the knee in children are common presentations in day to day practice. While some of the deformities are physiological that need careful observation, the others are pathological and need timely medical or surgical intervention. Systematic evaluation of the deformity is the first step in making the correct decision about the management. The right choice of treatment, the correct timing and perfect execution of the technique are necessary for optimum outcome. This article describes the aetiology, clinicoradiological evaluation and management of angular deformities around the knee in children.

Keywords: Knee, Angular deformity, Children.


References

  1. SeleniusP., Vankka E.: The development of the tibiofemoral angle in children J. Bone Joint Surg Am.1975, 57:259-261.
  2. Valentino Coppa, Mario Marinelli: Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment World Journal of Orthopaedics 2022, May 13(5):427-443.
  3. Davids JR, Blackhurst DW. Clinical evaluation of bowed legs in children JPO B 2000 Oct 9(4): 278-284.
  4. Paley D. Principles of deformity correction Heidelberg, Springer, 2002:1-18.
  5. Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs: Preoperative planning of uniapical angular deformities of the tibia or femur CORR 1992, 48-64.
  6. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate JPO 2007, 27:253-259.
  7. Eltayeby HH, Lobst CA. Hemiepiphysiodesis using tension band plates: does the initial screw angle influence the rate of correction? J. Child Ortho. 2019, Feb. 13(1): 62-66.
  8. Metaizeau JP, Wong-ChungJ. Percutaneous epiphysiodesis using transphyseal screws(PETS) JPO1998,18:363-369.
  9. White GR, Mencio GA: Genu valgum in children: Diagnostic and therapeutic alternatives JAAOS:1995;3 (5):275-283.
  10. Tachdjian’s Paediatric Orthopaedics. 3rd ed. 2002, Vol. 3:839-890.
How to Cite this article: Sheth B. Non Standard Deviation – Managing angular deformities around the knee in young agee. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):32-37.

 (Abstract    Full Text HTML)   (Download PDF)