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Kim JI, Kim JK, Kang MW, Han HS. Do the Clinical and Radiological Features of Knees with Mucoid Degeneration of the Anterior Cruciate Ligament Differ According to Knee Osteoarthritis Status? Clin Orthop Surg 2024; 16:405-412. [PMID: 38827759 PMCID: PMC11130624 DOI: 10.4055/cios23051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 06/05/2024] Open
Abstract
Background The etiology and pathology of mucoid degeneration of the anterior cruciate ligament (MD-ACL) remain poorly understood. MD-ACL may be associated with knee osteoarthritis (OA) or a mechanism other than OA. This study evaluated the radiological differences between knees with MD-ACL and those with a normal ACL and compared the clinical and radiological features of knees with MD-ACL according to the knee OA status. Methods This retrospective study compared the radiological features of the intercondylar notch width index (NWI) and posterior tibial slope (PTS) of 67 MD-ACL patients (MD group) and 67 age-, sex-, and OA grade-matched patients with a normal ACL (control group). During the subgroup analysis, MD-ACL patients were divided into the non-OA subgroup (n = 41) and OA subgroup (n = 26). The pain location and characteristics of the knee, PTS, and NWI were compared between these subgroups. Results Compared to the control group, the MD group had a lower NWI (0.26 ± 0.03 vs. 0.28 ± 0.01, p < 0.001) and a larger PTS (11.3° ± 3.0° vs. 9.2° ± 2.5°, p < 0.001). During the subgroup analysis, the most common pain locations were the posterior and medial aspects of the knee in the non-OA subgroup (43.9%) and OA subgroup (53.8%), respectively. Pain on terminal flexion was the most common pain characteristic in both subgroups (non-OA subgroup, 73.1%; OA subgroup, 53.8%). The PTS was not different between subgroups (11.7° ± 3.2° in the non-OA subgroup vs. 10.6° ± 2.7° in the OA subgroup; p = 0.159). However, the non-OA subgroup had a lower NWI than the OA subgroup (0.25 ± 0.03 vs. 0.28 ± 0.02, p = 0.001). Conclusions Patients with MD-ACL had a lower NWI and a larger PTS than patients with a normal ACL. Furthermore, the clinical and radiological features of MD-ACL differed according to the knee OA status. A narrow intercondylar notch may be more closely associated with the development of MD-ACL without OA.
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Affiliation(s)
- Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jong-Keun Kim
- Department of Orthopaedic Surgery, Heung-K Hospital, Siheung, Korea
| | - Min Wook Kang
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Toyono S, Suzuki A, Wanezaki Y, Takahara D, Ohe R, Fukushima S, Futakuchi M, Takagi M. Predicting anterior cruciate ligament degeneration using magnetic resonance imaging: Insights from histological evaluation. J Orthop Sci 2024:S0949-2658(24)00090-3. [PMID: 38772763 DOI: 10.1016/j.jos.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 04/24/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Mucoid degeneration of the anterior cruciate ligament is a pathological condition that may impair knee mechanics and contribute to the symptomatology of osteoarthritis. This study aimed to evaluate whether preoperative magnetic resonance imaging can predict anterior cruciate ligament degeneration, specifically mucoid degeneration, and to elucidate the histopathological characteristics of mucoid degeneration in knee osteoarthritis patients. METHODS We evaluated a total of 95 knees of osteoarthritis patients (23 males, 72 females; mean age: 72.7 ± 7.5) scheduled for total knee arthroplasty. The relationship between preoperative magnetic resonance imaging findings and the histopathological evidence of anterior cruciate ligament mucoid degeneration was examined. Immunohistochemical analysis was employed for collagen types (COL-I, COL-II), chondrogenesis (SOX9), and vascularity (CD31). RESULTS High signal intensity on magnetic resonance imaging showed a positive correlation with Alcian Blue staining areas (rs = 0.59, p < 0.01) and the swelling index (rs = 0.62, p < 0.01), indicating advanced mucoid degeneration. The absence of synovial lining around the anterior cruciate ligament was associated with more severe degeneration. In the histological evaluations, advanced degeneration was characterized by an increase in chondroid metaplasia and collagen disorientation. The Alcian Blue and SOX9 correlation was positive (rs = 0.69, p < 0.01), but negative with COL-I (rs = -0.38, p = 0.03) and vascularity (CD31) (rs = -0.60, p < 0.01). CONCLUSIONS Preoperative magnetic resonance imaging is an effective tool in assessing the severity of anterior cruciate ligament degeneration; it influences surgical decisions. High signal intensity on magnetic resonance images denotes advanced mucoid degeneration. The absence of synovial lining around the anterior cruciate ligament is associated with more severe degeneration and may accelerate degenerative changes. Chondroid metaplasia and collagen disorientation mark advanced degeneration. Magnetic resonance imaging can be used to gauge the degree of anterior cruciate ligament degeneration in osteoarthritis.
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Affiliation(s)
- Shuji Toyono
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan; Department of Orthopaedic Surgery, Saiseikai Yamagata Saisei Hospital, Yamagata, Yamagata, 990-8545, Japan.
| | - Akemi Suzuki
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Yoshihiro Wanezaki
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Daiichiro Takahara
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Rintaro Ohe
- Department of Pathology, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Shigenobu Fukushima
- Department of Orthopaedic Surgery, Saiseikai Yamagata Saisei Hospital, Yamagata, Yamagata, 990-8545, Japan
| | - Mitsuru Futakuchi
- Department of Pathology, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
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Luo J, Zhou M, Luo X, Luo P, Yang Z, Li R, Duan C, Feng X, Wu T. Mucoid Degeneration of the Anterior Cruciate Ligament: Characteristics and Conservative Management. J Knee Surg 2024; 37:198-204. [PMID: 36807100 DOI: 10.1055/a-2037-6138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Clinical and radiographic characteristics of mucoid degeneration of the anterior cruciate ligament (MD-ACL) were poorly documented in previous literature. And the optimal management strategy for MD-ACL remains unclear. Here, we summarized the characteristics associated with MD-ACL, and evaluated the clinical outcome of conservative management to MD-ACL.A total of 18 knees in 18 patients diagnosed with MD-ACL were collected and reviewed retrospectively. Sixteen patients underwent conservative management and two patients underwent arthroscopic surgery. Baseline demographic, clinical data, and pathologic changes of knee in magnetic resonance imaging (MRI) were recorded. Clinical outcome was evaluated with Visual Analogue Scale (VAS) and Oxford Knee Score (OKS).The most common clinical characteristic in patients with MD-ACL was knee pain (18/18), and seconded by mobility limitation (38.9%, 7/18). All patients presented a typical celery stalk sign with increased signal and diffuse thickening volume in the ACL in MRI. Thirteen patients companied with meniscus tear (72.2%, 13/18), and nine complicated with cartilage injury (50.0%, 9/18). Sixteen patients who underwent conservative treatment were followed up for 21.8 months, and a positive clinical outcome was observed with VAS decreasing from 5.3 ± 2.3 to 1.5 ± 1.9 and OKS decreasing from 27.5 ± 12.7 to 17.9 ± 11.8 (p < 0.001). The post-OKS score was highly correlated with age, duration of disease, and meniscus tear (r = 0.844, 0.707, and 0.474, p < 0.05, respectively). And the post-VAS highly correlated with age (r = 0.693, p < 0.05). Two patients who underwent arthroscopic surgery were followed up for 24.5 months, and the pain and function of knee was improved.Knee pain and meniscus tear was the main characteristic of MD-ACL in clinical and radiographic exam. Conservative treatment could be an alternative management for treatment of MD-ACL with positive clinical outcome. Old age, long duration of disease and complications from meniscus tears were associated with inferior outcome of conservative treatment for MD-ACL. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Jianzhou Luo
- Health Science center, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Minmin Zhou
- Health Science center, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
- Department of Radiology, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xiaozhen Luo
- Department of Radiology, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Peng Luo
- Department of Radiology, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Zili Yang
- Health Science center, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Ruifang Li
- The First Clinical Medical College, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Chunguang Duan
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xujiao Feng
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Tailin Wu
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
- Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen, Guangdong, People's Republic of China
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Crouser N, Wright J, DiBartola A, Flanigan D, Duerr R. Intercondylar Notch Pathology. J Knee Surg 2024; 37:149-157. [PMID: 36539213 DOI: 10.1055/a-2001-6764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The intercondylar notch of the knee is a relatively small area. However, numerous rare pathologies can arise in this region. A majority of the existing literature has focused on the cruciate ligament injuries, yet there are several other entities that can cause knee pain from within the intercondylar notch. This review focuses on identifying the various diagnostic and treatment options for rare benign and malignant lesions including ganglion cyst formation, mucoid degeneration, benign proliferative conditions, and intra-articular tumors. These entities are most often diagnosed with advanced imaging studies and treated arthroscopically. While rare, these pathologies are important to identify in patients with ongoing vague knee pain.
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Affiliation(s)
- Nisha Crouser
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jonathan Wright
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alex DiBartola
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert Duerr
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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El Alaoui O, Jelti O, Lachkar A, Abdeljaouad N, Yacoubi H. Mucoid Degeneration of the Anterior Cruciate Ligament: A Case Report. Cureus 2023; 15:e50545. [PMID: 38222208 PMCID: PMC10787846 DOI: 10.7759/cureus.50545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Mucoid degeneration (MD) is an uncommon pathological phenomenon that specifically affects the anterior cruciate ligament (ACL). This condition arises from the infiltration of yellowish material within the fibers of the ACL, contributing to the clinical presentation characterized by discomfort and limited mobility. MRI has proven to be the foremost diagnostic modality in effectively distinguishing MD of ACL from other potential pathologies. Preoperative recognition of this condition facilitates straightforward diagnosis, particularly via characteristic findings observed during knee arthroscopy. We present a case of MD of ACL, review prior studies about the condition, and outline its clinical features and symptoms, including those observed in our specific case.
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Affiliation(s)
- Oussama El Alaoui
- Orthopaedics and Traumatology, University Hospital Mohammed VI, Oujda, MAR
| | - Ousama Jelti
- Orthopaedics, University Hospital Mohammed VI, Oujda, MAR
| | - Adnane Lachkar
- Orthopaedics and Traumatology, University Hospital Mohammed VI, Oujda, MAR
| | - Najib Abdeljaouad
- Orthopaedics and Traumatology, University Hospital Mohammed VI, Oujda, MAR
| | - Hicham Yacoubi
- Orthopaedics and Traumatology, University Hospital Mohammed VI, Oujda, MAR
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Haidar I, Hardy A, Bohu Y, Meyer A, Lefevre N. Clinical outcomes of arthroscopic partial resection of mucoid degeneration of anterior cruciate ligament. INTERNATIONAL ORTHOPAEDICS 2023; 47:2961-2965. [PMID: 37526678 DOI: 10.1007/s00264-023-05901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/15/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Mucoid degeneration of the anterior cruciate ligament is rare condition; mucoid degeneration affects the range of motion of the knee with pain on terminal extension and terminal flexion. Arthroscopic treatment of the mucoid anterior cruciate ligament (ACL) is the treatment of choice. The purpose of this study was to provide demographic and clinical characteristic of mucoid degeneration of ACL and assess the outcomes of partial arthroscopic ACL resection. METHODS Patients who underwent partial ACL resection for mucoid degeneration between February 2007 and February 2019 were considered for study eligibility. Patients were evaluated for International Knee Documentation Committee (IKDC), The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI), The Knee injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale. RESULTS Sixty patients underwent partial ACL resection for mucoid degeneration of the ACL. Nine patients were lost to follow-up, 43 were males, the average age was 52.12±12.09 and a mean follow-up of 83.55±44.79 months. At final follow-up six patients underwent ACL reconstruction for ACL rupture (11.7%) at an average of 15.66±12 months. Patient satisfaction was at 71%. CONCLUSION Arthroscopic partial resection of the ACL led to good clinical outcome for treating mucoid degeneration of the ACL.
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Affiliation(s)
- Ibrahim Haidar
- Orthopedic Department, Emirates Hospital, Jumeirah Beach Rd, Jumeirah 2, Dubai, United Arab Emirates.
| | - Alexandre Hardy
- Orthopedic Department, Clinique du sport, 30 Boulevard Saint-Marcel, Paris, 75005, France
| | - Yoann Bohu
- Orthopedic Department, Clinique du sport, 30 Boulevard Saint-Marcel, Paris, 75005, France
| | - Alain Meyer
- Orthopedic Department, Clinique du sport, 30 Boulevard Saint-Marcel, Paris, 75005, France
| | - Nicolas Lefevre
- Orthopedic Department, Clinique du sport, 30 Boulevard Saint-Marcel, Paris, 75005, France
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Marques FDS, Alves PBR, Zelada S, Nunes RPDS, Alves WM, Campos GCD. An Unusual Cause of Posterior Knee Pain: Mucoid Degeneration of the Anterior Cruciate Ligament - Case Report. Rev Bras Ortop 2023; 58:e826-e830. [PMID: 37908529 PMCID: PMC10615596 DOI: 10.1055/s-0040-1722593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/16/2020] [Indexed: 10/21/2022] Open
Abstract
Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon cause of pain in the posterior region of the knee, of unknown pathophysiology and underdiagnosed. The best treatment modality is still under discussion. Resection of the lesion with partial ACL debridement has shown good results without the occurrence of instability. The authors present a case of mucoid degeneration of the ACL treated with resection of the mucoid degeneration and partial debridement of the ACL by arthroscopy.
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Affiliation(s)
- Fabiano da Silva Marques
- Departamento de Ortopedia, Instituto Wilson Mello, Campinas, São Paulo, Brasil
- Grupo de Cirurgia do Joelho, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brasil
| | - Pedro Bezzan Rodrigues Alves
- Departamento de Ortopedia, Instituto Wilson Mello, Campinas, São Paulo, Brasil
- Grupo de Cirurgia do Joelho, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brasil
| | - Sandro Zelada
- Departamento de Ortopedia, Instituto Wilson Mello, Campinas, São Paulo, Brasil
- Grupo de Cirurgia do Joelho, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brasil
| | - Rodrigo Pereira da Silva Nunes
- Departamento de Ortopedia, Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brasil
- Clínica Nunes de Ortopedia e Traumatologia (CNOT), Campinas, São Paulo, Brasil
| | - Wilson Mello Alves
- Departamento de Ortopedia, Instituto Wilson Mello, Campinas, São Paulo, Brasil
- Grupo de Cirurgia do Joelho, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brasil
| | - Gustavo Constantino de Campos
- Departamento de Ortopedia, Instituto Wilson Mello, Campinas, São Paulo, Brasil
- Departamento de Ortopedia, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brasil
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8
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Cilengir AH, Akkus OK, Baysan C, Uluc E, Cilengir N, Tosun O. Ancillary findings in distinguishing between anterior cruciate ligament mucoid degeneration and sprain on MRI: a practical approach. Acta Radiol 2023; 64:648-657. [PMID: 35484786 DOI: 10.1177/02841851221090623] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Imaging findings of both anterior cruciate ligament (ACL) sprain and mucoid degeneration overlap in some cases, which may cause errors in magnetic resonance imaging (MRI) evaluation. PURPOSE To determine the ancillary findings on MRI in distinguishing between ACL sprain and mucoid degeneration, and also to obtain a diagnostic scheme. MATERIAL AND METHODS MRI scans of 77 patients with ACL mucoid degeneration and 77 cases with ACL sprain were retrospectively evaluated to compare with regard to parameters of age, sex, side, the status of posterior cruciate ligament - medial collateral ligament - lateral collateral ligament, bone marrow edema, intraosseous cyst, subchondral sclerosis, chondromalacia, meniscus tear, effusion, and osteochondral body. A decision tree algorithm was created to predict pathology in ACL, whether it was a sprain or mucoid degeneration. RESULTS The prevalence of female sex, femoral intraosseous cyst, tibial intraosseous cyst, subchondral sclerosis, femoral chondromalacia, tibial chondromalacia, medial meniscus tear, and lateral meniscus tear were significantly higher in the ACL mucoid degeneration group (P < 0.001, P = 0.016, P < 0.001, P = 0.003, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). The probability of being mucoid degeneration increased 41.2 times (95% confidence interval [CI] = 5.296-321.132) in cases with tibial intraosseous cyst and increased 1.05 times (95% CI = 1.010-1.080) with each one-year increase in age (P < 0.001 and P = 0.011, respectively). The decision tree algorithm had an overall accuracy of 79.2%. CONCLUSION Ancillary findings are helpful in the diagnosis of suspicious cases for ACL mucoid degeneration and ACL sprain. The decision tree algorithm offers a practical and successful approach to this issue.
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Affiliation(s)
| | - Onur Kaan Akkus
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Caner Baysan
- Department of Public Health/Epidemiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Engin Uluc
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nevin Cilengir
- Faculty of Medicine, Department of Radiology, Ege University, Izmir, Turkey
| | - Ozgur Tosun
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Kodama Y, Furumatsu T, Tamura M, Okazaki Y, Hiranaka T, Kamatsuki Y, Ozaki T. Steep posterior slope of the medial tibial plateau and anterior cruciate ligament degeneration contribute to medial meniscus posterior root tears in young patients. Knee Surg Sports Traumatol Arthrosc 2023; 31:279-285. [PMID: 35978177 DOI: 10.1007/s00167-022-07095-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Medial meniscus posterior root tears (MMPRTs) occur most frequently in middle-aged and older adults. However, this serious condition can also occur in younger patients. The purpose of this study was to compare anterior cruciate ligament (ACL) degeneration and sagittal medial tibial slope in young adults with and without MMPRT. METHODS Eighteen healthy volunteers, 18 young patients (20-49 years of age), and 30 middle-aged and older patients (50-70 years of age) with MMPRT repair were included in the study. Sex, body mass index (BMI), femorotibial angle, ACL degeneration, and medial tibial slope angle were compared among the groups. ACL degeneration and medial tibial slope angle were assessed using magnetic resonance imaging. RESULTS In the healthy volunteer group, the young patient group, and the older patient group, the medial tibial slopes were 3.5° ± 1.4°, 6.1° ± 2.7°, and 7.2° ± 1.9°, respectively, and the ACL degeneration rates were 5.6%, 38.9%, and 43.3%, respectively. Young patients with MMPRT had significantly steeper medial tibial slopes and ACL degeneration compared to those of the healthy volunteers (P < 0.05). The parameters of young patients were similar to those of older patients with MMPRT. In the multivariate logistic regression analysis, BMI, medial tibial slope, and ACL degeneration were significantly associated with MMPRT in young patients. CONCLUSION BMI, steep medial tibial slope, and ACL degeneration contribute to MMPRT development in younger patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.,Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama, 702-8055, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.,Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi, 781-8555, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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Clinical and radiological comparison between partial and complete resection of the anterior cruciate ligament in patients with mucoid degeneration of the anterior cruciate ligament: a controlled clinical trial. Arch Orthop Trauma Surg 2022. [PMID: 36574067 PMCID: PMC10374792 DOI: 10.1007/s00402-022-04741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The pathology of a mucoid degeneration of the anterior cruciate ligament (MDACL) has been mentioned in several publications but due to its rare incidence it is not a well-known pathology. Partial or complete resection of the ACL is the option of choice after failed non-surgical treatment. However, the success rate of both surgical techniques and the subsequent risk of an ACL instability is not known. The purpose of this study was to compare the clinical and radiological outcome between partial resection and complete resection of the ACL in patients with MDACL. MATERIALS AND METHODS Patients with MDACL verified by MRI and persistent knee pain were treated by partial (Group I) or complete resection (Group II) of the ACL and were included in a controlled clinical trial after unsuccessful conservative treatment for at least 6 months. Demographic, clinical and radiological data including the thickness of ACL, ACL/intercondylar ratio, patient's age at the time of surgery, the presenting symptoms, range of motion and ligament stability assessed by the ACL ligament score (Lachman test) were collected. In addition, Tegner activity score and Lysholm score were evaluated preoperatively and at final follow-up after a minimum of 12 months. RESULTS At final follow-up with a mean of 16.8 ± 8.8 months (range 12-41; Group I: 18.3 ± 9.7 vs. Group II: 15.3 ± 8.0; ns), all patients were pain free. Postoperatively, positive Lachman tests were noted in all patients (100%) in Group II (n = 5 patients with grade II and n = 5 patients with grade III). In Group I, 8 patients (80%) showed a negative Lachman test (grade I) and 2 patients (20%) a slightly elongated Lachman test with a firm stop (grade II). The mean knee flexion at follow-up examination was 132° ± 7° (range 120°-140°; Group I: 129° ± 9° vs. Group II: 135° ± 4°; ns). In pairwise comparison, flexion angle increased significantly in both groups (Group I: p = 0.0124 and Group II: p < 0.001). Pairwise comparison of thickness of the ACL and ACL/intercondylar ratio prior to and post-surgery in Group I showed non-significant differences. CONCLUSION Both arthroscopic debridement and complete resection of the ACL lead to improvement of clinical and radiological findings in isolated MDACL. However, complete resection of the ACL will result in higher instability. Therefore, partial resection might be the better treatment option, especially in young patients with MDACL.
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11
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Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04659-z. [PMID: 36434266 DOI: 10.1007/s00402-022-04659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a well-recognized pathology characterized by the degradation of collagen fibers and infiltration of a mucoid-like substance. This study is to determine the anatomical associated factors for MD-ACL using radiographic and magnetic resonance imaging (MRI). MATERIALS AND METHODS This was a retrospective study on patients who had undergone knee arthroscopy between 2011 and 2020. The patients with MD-ACL were defined and enrolled by the MRI and arthroscopy. Eventually, 52 patients in the MD-ACL group (group 1) and 52 patients in the control group (group 2) were enrolled, following sex and age matching. Radiologic evaluation included the assessment of Kellgren-Lawrence (K-L) grade, mechanical hip-knee-ankle (HKA) angle, posterior tibial slope (PTS) angle, and Insall-Salvati ratio. The notch width index and transverse notch angle were measured on MRI, and the grade of trochlear dysplasia was defined. Logistic regression analysis, receiver operating characteristic (ROC) curves, and area under curve (AUC) were performed. RESULTS The ROM was significantly decreased in group 1, whereas the PTS angle was significantly larger in group 1. Combined ganglion cysts of ACL were found in 42/52 patients (80.7%) in group 1. The risk of MD-ACL was associated with a steeper PTS angle, increased Insall-Salvati ratio, male sex, higher K-L grade, and decreased transverse notch angle and notch width index. The cutoff values in ROC analysis were found to be ≤ 28.27% for the notch width index (AUC, 0.849; p < 0.001), > 12.2° for the PTS angle (AUC, 0.765; p < 0.001), and ≤ 47.4° for the transverse notch angle (AUC, 0.711; p < 0.001), but not significant for Insall-salvati ratio. CONCLUSION A steeper PTS angle, decreased notch width index, and transverse notch angle are significantly associated with the presence of MD-ACL. These factors should be considered during diagnosis or when determining the treatment strategy for symptomatic MD-ACL patients. LEVEL OF EVIDENCE Level IIIb.
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Xu J, Lian Y, Sun S, Yang Z, Chen H. Diagnostic Performance of Multi-Direction Adjusted Multi-Planar Reconstruction with Helical CT for Evaluating Continuity of the Anterior Cruciate Ligament. Acad Radiol 2022; 29:e240-e247. [PMID: 35246375 DOI: 10.1016/j.acra.2021.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the diagnostic performance of MDA-MPR with CT for evaluating ACL structural continuity. METHODS A total of 145 patients with highly suspected ACL injury admitted to our hospital between January 2016 and May 2021 were retrospectively enrolled. All patients had undergone examination with MRI, CT, and arthroscopy. Taking arthroscopy results as the gold standard, the diagnostic accuracy for identifying ACL rupture by MRI and MDA-MPR with CT were compared. RESULTS The receiver operator characteristic curves demonstrated that both MRI and MDA-MPR with CT performed well in the diagnosis of ACL tears. The sensitivities of MRI and MDA-MPR with CT for diagnosing complete ACL tears were 95.16% (59/62) and 90.32% (56/62), respectively. Their specificities in this regard were 77.11% (64/83) and 84.34% (70/83), respectively. MRI had a higher sensitivity but MDA-MPR with CT had a higher specificity for detecting complete ACL tears, and the differences were statistically significant (p <.05). The sensitivities of diagnosing partial ACL tears using MRI and MDA-MPR with CT were 78.79% (26/33) and 75.76% (25/33), respectively, while the specificities were 86.61% (97/112) and 90.18% (101/112), respectively. These differences were non-significant (p >.05). CONCLUSION MDA-MPR with CT has high diagnostic efficiency for ACL injuries, especially in the diagnosis of complete ACL tears.
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Affiliation(s)
- Jun Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Yuanyuan Lian
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Shiqing Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Zhitao Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China.
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Kakigi T, Sakamoto R, Tagawa H, Kuriyama S, Goto Y, Nambu M, Sagawa H, Numamoto H, Miyake KK, Saga T, Matsuda S, Nakamoto Y. Diagnostic advantage of thin slice 2D MRI and multiplanar reconstruction of the knee joint using deep learning based denoising approach. Sci Rep 2022; 12:10362. [PMID: 35725760 PMCID: PMC9209466 DOI: 10.1038/s41598-022-14190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to evaluate whether thin-slice high-resolution 2D fat-suppressed proton density-weighted image of the knee joint using denoising approach with deep learning-based reconstruction (dDLR) with MPR is more useful than 3D FS-PD multi planar voxel image. Twelve patients who underwent MRI of the knee at 3T and 13 knees were enrolled. Denoising effect was quantitatively evaluated by comparing the coefficient of variation (CV) before and after dDLR. For the qualitative assessment, two radiologists evaluated image quality, artifacts, anatomical structures, and abnormal findings using a 5-point Likert scale between 2D and 3D. All of them were statistically analyzed. Gwet’s agreement coefficients were also calculated. For the scores of abnormal findings, we calculated the percentages of the cases with agreement with high confidence. The CV after dDLR was significantly lower than the one before dDLR (p < 0.05). As for image quality, artifacts and anatomical structure, no significant differences were found except for flow artifact (p < 0.05). The agreement was significantly higher in 2D than in 3D in abnormal findings (p < 0.05). In abnormal findings, the percentage with high confidence was higher in 2D than in 3D (p < 0.05). By applying dDLR to 2D, almost equivalent image quality to 3D could be obtained. Furthermore, abnormal findings could be depicted with greater confidence and consistency, indicating that 2D with dDLR can be a promising imaging method for the knee joint disease evaluation.
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Affiliation(s)
- Takahide Kakigi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Tagawa
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihito Goto
- Department of Health Informatics, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Masahito Nambu
- MRI Systems Division, Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara, Tochigi, 324-8550, Japan
| | - Hajime Sagawa
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hitomi Numamoto
- Department of Advanced Medical Imaging Research, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kanae Kawai Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Advanced Medical Imaging Research, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tsuneo Saga
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Advanced Medical Imaging Research, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Banerjee S, Munde K, Kunal K. Mucoid degeneration of the anterior cruciate ligament: can platelet-rich plasma combined with reductionplasty provide better results? Regen Med 2022; 17:617-626. [PMID: 35703034 DOI: 10.2217/rme-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. Methodology: Five patients who were diagnosed as a case of mucoid degeneration of the ACL based on MRI, over a period of 1 year (December 2018-2019), were included in the study. Autologous PRP, prepared by double spin protocol, was injected into the remaining ACL after partial debridement was done. Results: Visual analogue scale and Lysholm scores improved compared with preoperative scores, along with strength (anterior drawer test and Lachman test). Conclusion: PRP can be used to improve the healing and strength of a weakened ACL after partial debridement, but further research is needed to demonstrate its efficacy.
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Affiliation(s)
- Sumit Banerjee
- Additional Professor, Department of Orthopaedics, AIIMS Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Kishor Munde
- Senior Resident, Department of Orthopaedics, AIIMS Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Kishor Kunal
- Senior Resident, Department of Orthopaedics, AIIMS Jodhpur, Jodhpur, Rajasthan, 342005, India
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15
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Solís GS, Waghchoure C, Vinagre G. Symptomatic ACL mucoid degeneration in middle-age athletes. J Orthop 2022; 31:67-71. [PMID: 35496356 PMCID: PMC9038521 DOI: 10.1016/j.jor.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon non-traumatic cause of knee pain and motion restriction, typically seen in a middle-aged population. Primarily, the management consists of partial arthroscopic debridement and notchplasty, which has proven satisfactory clinical and functional outcomes. Study objectives This review aims to highlight key clinical, radiological and arthroscopic findings of mucoid ACL degeneration, and also to provide an approach to manage a symptomatic middle-aged athlete. Rationale Due to the paucity of literature on ACL mucoid degeneration, symptomatic presentation in a middle-aged athlete can be challenging to manage. Diffuse central pain, motion restriction in extension or flexion, absence of trauma, and an intact enlarged ACL on Magnetic resonance imaging (MRI) should raise suspicion for mucoid degeneration in middle-aged athletes. Specific radiological and arthroscopic findings can help to confirm the diagnosis. In this review article, we have also described a new clinical test to mimic the pain due to anterior impingement in the presence of an enlarged ACL. Conclusion In symptomatic middle-aged athletes, knowledge of characteristic findings can help in the timely diagnosis of mucoid degeneration of ACL. Treatment options include arthroscopic debridement, notchplasty, ACL augmentation, and ACL reconstruction. The presence of associated injuries can influence return-to-sports prognosis.
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Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. J Int Med Res 2022; 50:3000605221084865. [PMID: 35272510 PMCID: PMC8921757 DOI: 10.1177/03000605221084865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) findings of a tram-track appearance and celery stalk appearance in mucoid degeneration of the cruciate ligament are valuable; however, their pathological basis is unclear. Because these appearances are generally seen throughout the entire ligament, the association between MRI findings and pathological findings must be verified in specimens of the whole degenerated ligament, including the ligamentous attachments to bone. We herein report two cases of mucoid degeneration of the posterior cruciate ligament with osteoarthritis of the knee requiring total knee arthroplasty. The entire degenerated ligament, including the ligamentous attachments to bone, was removed and pathologically evaluated. On pathological examination, the central portion of the lesion showed typical mucoid degeneration, whereas the marginal and adherent portions showed normal ligament tissue, consistent with a tram-track appearance on T2-weighted MRI. The fibrous normal ligament tissues in the longitudinal direction in regions of mucoid degeneration were consistent with a celery stalk appearance on T2-weighted MRI. No mucoid degeneration was found in the attachment area. The tram-track appearance and celery stalk appearance of mucoid degeneration on MRI can be explained by the pathological findings.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
| | - Toshiro Otani
- Department of Orthopaedic Surgery, 38259International University of Health and Welfare Ichikawa Hospital, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kōnodai, Ichikawa city, Chiba 272-0827, Japan
| | - Yoshifumi Okada
- Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Shinsuke Aida
- Department of Pathology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
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Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. Case Rep Orthop 2021; 2021:5879121. [PMID: 34721915 PMCID: PMC8553514 DOI: 10.1155/2021/5879121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. We report a rare case of a patient diagnosed with bilateral mucoid degeneration of the ACL with AKP and no limited joint range of motion (ROM). A 59-year-old man with spontaneous right AKP was admitted to our hospital. He first underwent arthroscopic resection of the thickened medial plica protruding far into the medial patellofemoral joint (PFJ) but felt little effectiveness thereafter. He then had an arthroscopic release of the lateral patellar retinaculum because of valgus knee and patellar instability, which resulted in only temporary improvement. Then, the AKP relapsed, this time with limitations in the ROM. Magnetic resonance imaging (MRI0 showed a diffuse, thickened ACL with a high inhomogeneous intensity in the T2-weighted and proton density weighted images and which looked similar to a celery stalk. Based on the patient's history and MRI findings, we suspected mucoid degeneration of the ACL and subsequently performed arthroscopic excision. At the same time, AKP appeared on the other side. Since the MRI demonstrated a similar celery stalk image as before, the same operation was performed on this side, as well. Finally, AKP and the limitation of the ROM were relieved approximately one month after surgery. Due to the patient only suffering from AKP with a preserved ROM, it took about 14 months to diagnose this disease. It should, therefore, always be considered in cases of AKP alone.
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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; 33:26. [PMID: 34419162 PMCID: PMC8379741 DOI: 10.1186/s43019-021-00110-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported. METHODS A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS A total of nine studies were eligible for review. All nine studies assessed the outcome of arthroscopic debridement of MDACL. A total of 313 knees in 292 patients were included. The mean follow up ranged from 13 to 72 months. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). The rate of simultaneous meniscectomy ranged from 13 to 44%. Postoperative pain relief ranged from 53.8 to 95%. There was an improvement in postoperative range of motion and outcome scores (Lysholm and International Knee Documentation Committee scores and the Knee Injury and Osteoarthritis Outcome Score). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. The mean MINORS score was 9.5 out of 16 (4-12). CONCLUSIONS Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tamer Sweed
- University Hospitals of Derby and Burton, Uttoxeter Rd, Derby, DE22 3NE, UK.
| | - Mohamed Mussa
- Trauma and Orthopaedic Speciality Trainee, West Midlands Deanery, Birmingham Rotation, Birmingham, UK
| | - Ahmed El-Bakoury
- University Hospitals Plymouth NHS Trust, Plymouth, UK.,University of Alexandria, Alexandria, Egypt
| | - Guido Geutjens
- University Hospitals of Derby and Burton, Uttoxeter Rd, Derby, DE22 3NE, UK
| | - Andrew Metcalfe
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK
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Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Feuerriegel G, Jungmann PM, Guimaraes JB, Facchetti L, McCulloch CE, Makowski MR, Link TM. Anterior cruciate ligament abnormalities are associated with accelerated progression of knee joint degeneration in knees with and without structural knee joint abnormalities: 96-month data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2021; 29:995-1005. [PMID: 33775919 PMCID: PMC8217143 DOI: 10.1016/j.joca.2021.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare progression over 8 years in knee compositional cartilage degeneration and structural joint abnormalities in knees with different types of anterior cruciate ligament (ACL) abnormalities over 8 years. METHOD Baseline MR images of the right knees of 1899 individuals of the Osteoarthritis Initiative (OAI) with no evidence of or mild to moderate radiographic osteoarthritis were assessed for nontraumatic ACL abnormalities. The knees of 91 individuals showed nontraumatic ACL abnormalities (age 60.6 ± 9.8 y, 46 females; mucoid degeneration (MD), N = 37; complete tear (CT), N = 22; partial tear (PT), N = 32) and were frequency-matched to 91 individuals with normal ACL. MRIs were assessed for knee joint abnormalities using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) and cartilage T2 mapping at baseline, 4- and 8-year follow-up. RESULTS Over 8 years, cartilage T2 values of the medial tibia showed a significantly greater increase in individuals with MD, PT or CT compared to those with normal ACL (adjusted rate of change/year [95% confidence interval], normal ACL: 0.06 [0.01, 0.23], MD: 0.34 [0.07, 0.73], PT, 0.21 [0.02, 0.33], CT, 0.51 [0.16, 0.78]), indicating an association of ACL abnormalities and an increased progression rate of cartilage degeneration in subjects with and without knee joint degeneration. This effect was also seen in cartilage T2 values averaged over all compartments (normal ACL: 0.08 [0.05, 0.20] vs abnormal ACL: 0.27 [0.06, 0.56]). CONCLUSIONS Over 8 years, higher progression rates of cartilage degeneration, especially in the medial tibia, were associated with ACL abnormalities compared to those with normal ACL, in subjects with and without knee joint abnormalities.
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Affiliation(s)
- Alexandra S. Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco,Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany,Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt J. Schwaiger
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Gabby B. Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Georg Feuerriegel
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M. Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julio B. Guimaraes
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Marcus R. Makowski
- Department of Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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Clinical Outcomes of Arthroscopic Notchplasty and Partial Resection for Mucoid Degeneration of the Anterior Cruciate Ligament. J Clin Med 2021; 10:jcm10020315. [PMID: 33467062 PMCID: PMC7830593 DOI: 10.3390/jcm10020315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
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.
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Zikria B, Johnson A, Hafezi-Nejad N, Siddiqui Y, Kwee RM, Ahlawat S, Morelli JN, Fayad LM, Kompel AJ, Haj-Mirzaian A, Pishgar F, Demehri S. Association Between MRI-Based Tibial Slope Measurements and Mucoid Degeneration of the Anterior Cruciate Ligament: A Propensity Score-Matched Case-Control Study. Orthop J Sports Med 2020; 8:2325967120962804. [PMID: 33225010 PMCID: PMC7658517 DOI: 10.1177/2325967120962804] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022] Open
Abstract
Background The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established. Purpose To investigate whether MTS and LTS measurements are associated with the presence of ACL MD. Study Design Cross-sectional study; Level of evidence, 3. Methods Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models. Results Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD. Conclusion Excessive LTS was associated with the presence of ACL MD, independent of participants' age, sex, BMI, and cartilage damage severity.
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Affiliation(s)
- Bashir Zikria
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alex Johnson
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nima Hafezi-Nejad
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yalda Siddiqui
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.,Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert M Kwee
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Shivani Ahlawat
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - John N Morelli
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew J Kompel
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arya Haj-Mirzaian
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Farhad Pishgar
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
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22
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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; 104:36. [PMID: 32676546 PMCID: PMC7333554 DOI: 10.5334/jbsr.1654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To determine MRI findings that can differentiate anterior cruciate ligament (ACL) tears from mucoid degeneration. Material and Methods: Thirty-seven patients with complete ACL tears and 43 with ACL mucoid degeneration were included in this study. Discontinuity, the abnormal signal intensity of the ACL on fat-saturated-PD weighted images, contusions, a deep lateral femoral notch, anterior tibial translation, uncovered posterior horn of the lateral meniscus, a celery stalk appearance, thickening, ganglion cysts, intraosseous cysts, the ACL, Blumensaat, and posterior cruciate ligament (PCL) angles were evaluated. Optimum threshold values, sensitivity, specificity, and 95% CIs for the angles were calculated to predict the tear. Results: The prevalence of the significant findings in a tear versus mucoid degeneration, respectively, was as follows: discontinuity (97% vs. 0%, p < 0.001), contusions (65% vs. 2%, p < 0.001), the deep lateral femoral notch (22% vs. 0%, p = 0.001), anterior tibial translation (70% vs. 14%, p < 0.001), uncovered the lateral meniscus (46% vs. 7%, p < 0.001), a celery stalk appearance (0% vs. 66%, p < 0.001), thickening (19% vs. 100%, p < 0.001), ganglion cysts (14% vs. 70%, p < 0.001), and intraosseous cysts (8% vs. 63%, p < 0.001). Threshold values of ACL, Blumensaat, and PCL angles to predict the tear were ≤36° (78% sensitivity, 91% specificity), >11° (84%, 81%), and ≤96° (65%, 91%), respectively. Conclusion: A celery stalk appearance in the mucoid degeneration and discontinuity in an ACL tear are important in the differential diagnosis. ACL, Blumensaat, and PCL angles can be helpful in settings of diagnostic uncertainty.
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23
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Intraligamentous synovial chondromatosis of the anterior cruciate ligament. Skeletal Radiol 2020; 49:645-650. [PMID: 31760459 PMCID: PMC7024656 DOI: 10.1007/s00256-019-03346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/27/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023]
Abstract
Synovial chondromatosis is a rare disease that causes disability and dysfunction of the involved synovial joint. We describe the second case in the literature of intraligamentous synovial chondromatosis involving the anterior cruciate ligament, confirmed by pathology after arthroscopic removal of the chondral bodies. We also describe associated magnetic resonance imaging findings which may be helpful for diagnosis of this very rare entity.
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24
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Outcome analysis following arthroscopic augmentation with autologous hamstring graft in partial tear of the anterior cruciate ligament with preservation of an intact bundle: A case series. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Davis JE, Harkey MS, Ward RJ, MacKay JW, Lu B, Price LL, Eaton CB, Lo GH, Barbe MF, McAlindon TE, Driban JB. Accelerated knee osteoarthritis is associated with pre-radiographic degeneration of the extensor mechanism and cruciate ligaments: data from the Osteoarthritis Initiative. BMC Musculoskelet Disord 2019; 20:308. [PMID: 31253142 PMCID: PMC6599240 DOI: 10.1186/s12891-019-2685-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 06/18/2019] [Indexed: 11/30/2022] Open
Abstract
Background To determine if adults with incident accelerated knee osteoarthritis (KOA) are more likely to have degenerative knee ligaments or tendons compared to individuals with typical or no KOA. Methods We identified 3 sex-matched groups among Osteoarthritis Initiative participants who had a knee without radiographic KOA at baseline (Kellgren-Lawrence [KL] < 2): 1) accelerated KOA: at least 1 knee had KL grade ≥ 3 in ≤48 months, 2) typical KOA: at least 1 knee increased in radiographic scoring within 48 months, 3) no KOA: both knees had the same KL grade at baseline and 48 months. We evaluated knee magnetic resonance images up to 2 years before and after a visit when the accelerated or typical KOA criteria were met (index visit). Radiologists reported degenerative signal changes for cruciate and collateral ligaments, and extensor mechanism and proximal gastrocnemius tendons. We used generalized linear mixed models with 2 independent variables: group and time. Results Starting at least 2 years before onset, adults with accelerated KOA were twice as likely to have degenerative cruciate ligaments than no KOA (odds ratio = 2.10, 95% CI = 1.18, 3.74). A weaker association (not statistically significant) was detected for adults with accelerated versus typical KOA (OR = 1.72, 95%CI = 0.99, 3.02). Regardless of time, adults with accelerated (odds ratio = 2.13) or typical KOA (odds ratio = 2.16) were twice as likely to have a degenerative extensor mechanism than no KOA. No other structural features were statistically significant. Conclusions Degenerative cruciate ligaments or extensor mechanism antedate radiographic onset of accelerated KOA. Hence, knee instability may precede accelerated KOA, which might help identify patients at high-risk for accelerated KOA and novel prevention strategies.
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Affiliation(s)
- Julie E Davis
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Matthew S Harkey
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Robert J Ward
- Department of Radiology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - James W MacKay
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Bing Lu
- Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street PBB-B3, Boston, MA, 02115, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA.,Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington Street, Box #63, Boston, MA, 02111, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, 111 Brewster Street, Pawtucket, RI, 02860, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA.,Section of Immunology Allergy and Rheumatology, Baylor College of Medicine, Houston, TX. 1 Baylor Plaza, BCM-285, Houston, TX, 77030, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.
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26
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Harkey MS, Davis JE, Lu B, Price LL, Ward RJ, MacKay JW, Eaton CB, Lo GH, Barbe MF, Zhang M, Pang J, Stout AC, McAlindon TE, Driban JB. Early pre-radiographic structural pathology precedes the onset of accelerated knee osteoarthritis. BMC Musculoskelet Disord 2019; 20:241. [PMID: 31113401 PMCID: PMC6530034 DOI: 10.1186/s12891-019-2624-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 05/14/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Accelerated knee osteoarthritis (AKOA) is characterized by more pain, impaired physical function, and greater likelihood to receive a joint replacement compared to individuals who develop the typical gradual onset of disease. Prognostic tools are needed to determine which structural pathologies precede the development of AKOA compared to individuals without AKOA. Therefore, the purpose of this manuscript was to determine which pre-radiographic structural features precede the development of AKOA. METHODS The sample comprised participants in the Osteoarthritis Initiative (OAI) who had at least one radiographically normal knee at baseline (Kellgren-Lawrence [KL] grade < 1). Participants were classified into 2 groups based on radiographic progression from baseline to 48 months: AKOA (KL grade change from < 1 to > 3) and No AKOA. The index visit was the study visit when participants met criteria for AKOA or a matched timepoint for those who did not develop AKOA. Magnetic resonance (MR) images were assessed for 12 structural features at the OAI baseline, and 1 and 2 years prior to the index visit. Separate logistic regression models (i.e. OAI baseline, 1 and 2 years prior) were used to determine which pre-radiographic structural features were more likely to antedate the development of AKOA compared to individuals not developing AKOA. RESULTS At the OAI baseline visit, degenerative cruciate ligaments (Odds Ratio [OR] = 2.2, 95% Confidence Interval [CI] = 1.3,3.5), infrapatellar fat pad signal intensity alteration (OR = 2.0, 95%CI = 1.2,3.2), medial/lateral meniscal pathology (OR = 2.1/2.4, 95%CI = 1.3,3.4/1.5,3.8), and greater quantitative knee effusion-synovitis (OR = 2.2, 95%CI = 1.4,3.4) were more likely to antedate the development of AKOA when compared to those that did not develop AKOA. These results were similar at one and two years prior to disease onset. Additionally, medial meniscus extrusion at one year prior to disease onset (OR = 3.5, 95%CI = 2.1,6.0) increased the likelihood of developing AKOA. CONCLUSIONS Early ligamentous degeneration, effusion/synovitis, and meniscal pathology precede the onset of AKOA and may be prognostic biomarkers.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA. .,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Julie E Davis
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
| | - Bing Lu
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Robert J Ward
- Department of Radiology, Tufts Medical Center, Boston, MA, USA
| | - James W MacKay
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, RI, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA.,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Ming Zhang
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA.,Department of Computer Science & Networking, Wentworth Institute of Technology, Boston, MA, USA
| | | | - Alina C Stout
- Public Health Institute, Northeastern University, Boston, MA, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
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27
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Ventura D, Nuñez JH, Joshi-Jubert N, Castellet E, Minguell J. Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament. Clin Orthop Surg 2018; 10:307-314. [PMID: 30174806 PMCID: PMC6107816 DOI: 10.4055/cios.2018.10.3.307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/02/2018] [Indexed: 11/06/2022] Open
Abstract
Background Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. The aim of this study was to detail the clinical, radiological, arthroscopic, and pathological findings of mucoid degeneration of the anterior cruciate ligament and report the clinical outcomes following arthroscopic treatment. Methods A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. The minimum follow-up was 3 years. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Results Seventeen females (67%) and eight males (33%) were included in the final analysis. The mean age at the time of surgery was 57 years (range, 31 to 78 years). Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. No reconstruction was performed at the same time. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Conclusions Our study provides further evidence that arthroscopic total or partial excision of anterior cruciate ligament is a safe and effective treatment for mucoid degeneration of the anterior cruciate ligament, improving patient satisfaction and function without causing clinical instability in daily activities. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary.
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Affiliation(s)
- Diego Ventura
- Knee Unit, Department of Orthopedic Surgery, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jorge H Nuñez
- Knee Unit, Department of Orthopedic Surgery, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Knee and Spine Unit, Department of Orthopedic Surgery, University Hospital of Mutua Terrassa, Barcelona, Spain
| | - Nayana Joshi-Jubert
- Knee Unit, Department of Orthopedic Surgery, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Enric Castellet
- Knee Unit, Department of Orthopedic Surgery, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Minguell
- Knee Unit, Department of Orthopedic Surgery, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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28
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Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. Radiology 2018; 287:912-921. [PMID: 29465334 DOI: 10.1148/radiol.2018171565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To determine whether anterior cruciate ligament (ACL) mucoid degeneration in participants with or at risk for osteoarthritis is associated with longitudinal risk of radiographic progression of medial tibiofemoral compartment joint space loss (JSL). Materials and Methods Baseline demographic, clinical, radiographic, and Magnetic Resonance (MR) Imaging Osteoarthritis Knee Score (MOAKS) data were evaluated in 600 participants from the Osteoarthritis Initiative database. Two blinded musculoskeletal radiologists independently evaluated baseline MR images for ACL mucoid degeneration. Multiple logistic regression was used to investigate the association between ACL mucoid degeneration at MR imaging and JSL progression at radiography, defined as a minimum joint space width decrease greater than 0.7 mm (48 months; cutoff according to mean and standard deviation of 1-year minimum joint space width changes in 90 knees of reference group). Stratified analysis was performed based on baseline cartilage surface damage. Results Knees with ACL mucoid degeneration showed a greater proportion of JSL progression compared with knees with a normal ACL (64% vs 47%; P = .004). After adjustment for all demographic, clinical, radiographic, and MOAKS variables, ACL mucoid degeneration was not statistically significantly associated with JSL progression in the entire cohort (adjusted odds ratio, 1.66; 95% confidence interval: 1.00, 2.77; P = .051). In subgroup analysis, ACL mucoid degeneration was statistically significantly associated with JSL progression in participants with less baseline cartilage surface damage (maximum cartilage surface loss of ≤75% in all subregions [P = .015] and ≤4 of involved subregions with cartilage surface loss [P = .028]). Conclusion ACL mucoid degeneration in participants with or at risk for osteoarthritis is associated with progression of medial tibiofemoral compartment JSL in knees with less baseline cartilage surface area damage. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Robert M Kwee
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Nima Hafezi-Nejad
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Frank W Roemer
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Bashir A Zikria
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - David J Hunter
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Ali Guermazi
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
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Mathis DT, Hirschmann A, Falkowski AL, Kiekara T, Amsler F, Rasch H, Hirschmann MT. Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings. Knee Surg Sports Traumatol Arthrosc 2018; 26:563-573. [PMID: 28551834 DOI: 10.1007/s00167-017-4588-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/23/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) and single-photon emission computerised tomography/computerised tomography (SPECT/CT) are used as diagnostic tools in symptomatic patients after reconstruction of the anterior cruciate ligament (ACL). The benefit of SPECT/CT in comparison with MRI is under debate. The purpose of this study was to investigate whether and how bone tracer uptake (BTU) intensity and distribution in SPECT/CT correlate with MRI findings in symptomatic patients after ACL reconstruction. METHODS Twenty-nine patients (male:female = 22:7, mean age ± SD 26 ± 10 years) with symptoms of pain and instability after ACL reconstruction were retrospectively investigated using prospectively acquired SPECT/CT and MRI. On MRI graft tear, graft signal intensity, bone marrow oedema, tunnel cyst formation, roof impingement, roof osteophytes, local arthrofibrosis, joint effusion and synovial thickness were analysed by two readers blinded to the BTU results. BTU was anatomically localised and volumetrically quantified. Spearman's rho test was used for correlation of BTU in SPECT/CT and MRI findings (p < 0.05). RESULTS SPECT/CT showed increased femoral and tibial BTU in patients with MRI-confirmed graft tear, signal hyperintensity of the intraarticular graft section, joint effusion, synovial thickening, roof osteophytes and bone marrow oedema. Cyst formation in the femoral tunnel results in significantly reduced BTU in femur and tibia. No correlation of increased BTU was found for graft impingement and graft arthrofibrosis. CONCLUSIONS Bone tracer uptake in SPECT/CT and defined MRI findings in symptomatic patients after ACL reconstruction were correlated. Both imaging modalities have a definite role in post-operative diagnostic and have established their value in those patients. This study provides a better understanding of the clinical value of SPECT/CT versus MRI in the clinical decision-making process. SPECT/CT provides a window into the in vivo loading of the joint as well as bone remodelling and graft incorporation process. In addition, ACL graft insufficiency can be detected by increased BTU. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Dominic T Mathis
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - Anna Hirschmann
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, 4031, Basel, Switzerland
| | - Anna L Falkowski
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, 4031, Basel, Switzerland
| | - Tommi Kiekara
- Medical Imaging Centre, Tampere University Hospital, 33521, Tampere, Finland
| | | | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
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Faruch-Bilfeld M, Lapegue F, Chiavassa H, Sans N. Imaging of meniscus and ligament injuries of the knee. Diagn Interv Imaging 2016; 97:749-65. [DOI: 10.1016/j.diii.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Choubey R, Jain A. Mucoid Degeneration of the Anterior Cruciate Ligament: A Case Report and Review of Literature. J Orthop Case Rep 2016; 5:87-9. [PMID: 27299081 PMCID: PMC4719414 DOI: 10.13107/jocr.2250-0685.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. Patient having mucoid degeneration of ACL seeks multiple orthopedic consultation and most of the time treating orthopedican miss its diagnosis either because of lack of experience or rare cause of pain unless doctor sought magnetic resonance imaging (MRI) of knee. CASE REPORT We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. The patient presented with extension block of the knee. After arthroscopic debridement of the lesion, the patient regained full range of motion of the knee and were pain-free at follow-up. CONCLUSION A long duration of non-specific knee pain in a patient should be evaluated with MRI. Mucoid degeneration of the ACL is suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences in MRI is identified in a patient with physically intact ligament and no obvious trauma history. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient.
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Affiliation(s)
- Raghvendra Choubey
- Department of Orthopedics, Bundelkhand Medical College, Saugor, Madhya Pradesh, India
| | - Amit Jain
- Department of Anesthesia, Bundelkhand Medical College, Saugor, Madhya Pradesh, India
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Lee HNA, Ahn SE, Park JS, Ryu KN, Jin W, Park YK, Huh Y. Differences in MR signal intensity of lateral collateral ligament of knee joint on fat-suppressed proton density-weighted imaging. Br J Radiol 2016; 89:20150893. [DOI: 10.1259/bjr.20150893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Youm YS, Cho SD, 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; 28:34-8. [PMID: 26955611 PMCID: PMC4779803 DOI: 10.5792/ksrr.2016.28.1.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/09/2015] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose was to analyze the relationship between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL) in patients with total knee arthroplasty. Materials and Methods Four hundred and twenty-four patients (24 males and 400 females; 636 knees) who received total knee arthroplasty for osteoarthritis were included. Their mean age was 68.9 years (range, 48 to 88 years). The patients were classified into three groups according to the status of ACL; normal ACL group (group I), mucoid degeneration of ACL group (group II) and ruptured or absent ACL group (group III). Plain lateral radiographs were used to measure the PTS and the values were compared among groups. Results There were no significant differences with regard to gender, age and left-to-right side ratio among groups (p>0.05). The mean PTS was 9.9° (range, 0.6° to 20.1°) in group I (161 knees), 10.8° (range, 0.2° to 21.8°) in group II (342 knees) and 12.3° (range, 2° to 22.2°) in group III (133 knees), which showed significant differences (p<0.001). Conclusions The patients with mucoid degeneration of the ACL and those with ruptured or absent ACL had greater PTS than those with normal ACL. These findings suggest that an increased PTS may be one of the causative factors for mucoid degeneration of the ACL.
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Affiliation(s)
- Yoon-Seok Youm
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Sung-Do Cho
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Hye-Yong Cho
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Seung-Hyun Jung
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, Korea
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Kwee RM, Ahlawat S, Kompel AJ, Morelli JN, Fayad LM, Zikria BA, Demehri S. Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage. Osteoarthritis Cartilage 2015; 23:1543-50. [PMID: 25907861 DOI: 10.1016/j.joca.2015.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the prevalence of anterior cruciate ligament (ACL) mucoid degeneration in patients referred for routine knee magnetic resonance (MR) imaging, and its association with age and structural joint damage. METHOD Four independent radiologists assessed 413 consecutive knee MR examinations for the presence of a normal or ruptured ACL, or ACL mucoid degeneration. Knees with ACL mucoid degeneration were frequency matched by age, sex, and MR field strength with consecutive control knees with a normal ACL (1:2 ratio). Differences in meniscal and cartilage damage of the tibiofemoral compartments, as determined by the Whole-Organ MR Imaging Score (WORMS) system, were compared by Mann-Whitney U tests. Multivariable logistic regression analysis identified the association of ACL mucoid degeneration with severe MTFC cartilage damage (WORMS≥5). RESULTS Patients with ACL mucoid degeneration (n = 36; 36% males; median age 55.5 years, range: 26-81) were older than patients with a normal (P < 0.001) or ruptured ACL (P < 0.001), without sex predilection (P = 0.76), and were more frequently diagnosed at 3 T (12%) compared to 1.5 T (2%). Knees with ACL mucoid degeneration had statistically significantly more medial meniscal (P < 0.001) and central and posterior medial tibiofemoral compartment (MTFC) cartilage (P < 0.001) damage compared with control knees (n = 72), but there were no differences in patients ≤50 years (P = 0.09 and 0.32, respectively). In multivariable logistic regression, severe MTFC cartilage damage (WORMS≥5) was significantly associated with ACL mucoid degeneration (odds ratio 4.09, 95% confidence interval 1.29-12.94, P = 0.016). CONCLUSION There is a strong association between ACL mucoid degeneration and cartilage damage in the central and posterior MTFC, especially in patients >50 years.
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Affiliation(s)
- R M Kwee
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Ahlawat
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - A J Kompel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - J N Morelli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - L M Fayad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - B A Zikria
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Abstract
Knee osteoarthritis (KOA) is the most common degenerative arthritis and is treated by a wide range of practitioners. Treatment planning requires knowledge of the knee joint components and the influence of systemic and environmental factors. The treatment of KOA has changed little in 50 years. We are entering a new stage where KOA is now being viewed as an organ in failure. Neurotransmission of pain is both peripheral and central. Medical treatment can influence both pathways. Current guidelines for treatment have more rigid criteria based on the literature. In the future, the use of genetic-based biomarkers, clinical patterns of response and imaging characteristics will likely create subgroups of individuals who could benefit from improved designer therapies.
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Affiliation(s)
- Fred Rt Nelson
- Emeritus, Department of Orthopaedics, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202, USA;
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Kusano M, Horibe S, Tanaka Y, Yonetani Y, Kanamoto T, Shiozaki Y, Tsujii A. Early reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the anterior cruciate ligament. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:95-97. [PMID: 29264247 PMCID: PMC5730652 DOI: 10.1016/j.asmart.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/08/2015] [Accepted: 03/26/2015] [Indexed: 11/29/2022]
Abstract
Background Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. Although arthroscopic resection of the degenerated ACL is the treatment of choice following the failure of conservative management, the extent of the excision and subsequent ACL reconstruction for postoperative knee instability remains controversial. Case reports We present four cases of mucoid degeneration of the ACL in patients aged <40 years, and suggest a suitable treatment strategy for younger patients. All four patients (mean age, 33.8 years) were diagnosed with mucoid degeneration of the ACL based on characteristic clinical symptoms and magnetic resonance imaging. Arthroscopic resection of the affected portion of the ACL was performed as follows: partial resection in two cases with limited hypertrophy, and total ACL resection in the remaining two cases with degeneration involving the entire ligament. Preoperative symptoms disappeared in all cases after resection of the lesions. In the two patients with partial resection, the ACL was completely torn during subsequent sports activities despite showing no symptoms of instability for 2 years postoperatively. All four patients, including the two treated by total resection, underwent ACL reconstruction using an autogenous hamstring tendon. Conclusion Considering the rupture of residual ACL fibres after partial resection and the inevitability of total ACL resection due to degeneration of the entire ligament, ACL reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the ACL.
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Affiliation(s)
- Masashi Kusano
- Department of Orthopaedic Surgery, Seifu Hospital, Sakai, Japan
| | - Shuji Horibe
- Osaka Prefecture University, Graduate School of Comprehensive Rehabilitation, Habikino, Japan
| | - Yoshinari Tanaka
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
| | - Yasukazu Yonetani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanamoto
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
| | | | - Akira Tsujii
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Pandey V, Suman CPS, Sharma S, Rao SP, Kiran Acharya KV, Sambaji C. Mucoid degeneration of the anterior cruciate ligament: Management and outcome. Indian J Orthop 2014; 48:197-202. [PMID: 24741143 PMCID: PMC3977377 DOI: 10.4103/0019-5413.128765] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). Mucinous material within the substance of ACL produces pain and limited motion in the knee. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. MATERIALS AND METHODS During a period of 3 years, 11 patients were included based upon the clinical suspicion, magnetic resonance imaging (MRI) findings, arthroscopic features and histopathologic confirmation of MD of ACL. RESULT Six patients were male and five were female with median age of 40 years (range 21-59 years). All patients complained of knee pain with median duration of 5 months (range 1-24 months). All patients had painful deep flexion with 63.6% (N = 7) reporting trivial trauma before the onset of symptoms. MRI revealed MD of ACL in all with associated cyst in three patients. Partial debridement of ACL was done in ten and complete in one patient. None of them required notchplasty. Histopathology confirmed the diagnosis in all of them. At the mean followup of 13.81 months (range 6-28 months), all patients regained complete flexion and none complained of instability. CONCLUSION Prior knowledge of condition with high index of suspicion and careful interpretation of MRI can establish the diagnosis preoperatively. It responds well to partial debridement of ACL and mucinous material without development of instability.
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Affiliation(s)
- Vivek Pandey
- Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India,Address for correspondence: Dr. Vivek Pandey, Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal - 576 104, Karnataka, India. E-mail:
| | - CPS Suman
- Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Swati Sharma
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sripathi P Rao
- Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - KV Kiran Acharya
- Department of Orthopaedic Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Charudutt Sambaji
- Department of Radiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: a case report. Pan Afr Med J 2013; 15:59. [PMID: 24147185 PMCID: PMC3801231 DOI: 10.11604/pamj.2013.15.59.2534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 06/10/2013] [Indexed: 11/28/2022] Open
Abstract
We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint. If this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings.
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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; 99:693-7. [PMID: 23988420 DOI: 10.1016/j.otsr.2013.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/30/2013] [Accepted: 04/18/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The best treatment for anterior cruciate ligament (ACL) mucoid degeneration remains open to debate. Current options are total or partial ACL resection, or a more conservative strategy, reduction plasty. The goal of this study was to retrospectively evaluate the effects of reduction plasty for ACL hypertrophy due to mucoid degeneration from clinical outcome and knee laxity points of view. MATERIALS AND METHODS Arthroscopy was carried out on 23 knees (21 patients) to perform a circular volume reduction plasty of the ACL, while preserving the greatest number of ligament fibers. Notchplasty was not performed. All the patients were seen again with an average follow-up of 32 months (range 8-70). RESULTS All the knees except three had symmetric postoperative flexion. Three patients still had pain. No patient reported having subjective feelings of instability. Among the 20 knees tested with the GNRB(TM) knee laxity measurement device, one knee had a 2.4mm difference in laxity and three had between 3 and 4mm of difference; 16 knees had no residual laxity. DISCUSSION Treatment of ACL mucoid degeneration by reduction plasty leads to complete pain relief in 80% of cases while maintaining good postoperative knee stability. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- A Morice
- North Mayenne Hospital, Orthopaedic Department, 229, boulevard Paul-Lintier, 53100 Mayenne, France
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Tram-track appearance of the posterior cruciate ligament (PCL): correlations with mucoid degeneration, ligamentous stability, and differentiation from PCL tears. AJR Am J Roentgenol 2013; 201:394-9. [PMID: 23883220 DOI: 10.2214/ajr.11.7400] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to describe the MRI findings in the posterior cruciate ligament (PCL) analogous to mucoid degeneration in the anterior cruciate ligament (ACL); to correlate MRI findings in the PCL with ligamentous stability; to differentiate the PCL tram-track appearance from the appearance of PCL tears; and to emphasize the coexistence of PCL and ACL mucoid degeneration, cruciate ganglia, and meniscal cysts. CONCLUSION The tram-track PCL appearance commonly coexists with ACL mucoid degeneration; ganglia; and, less frequently, meniscal cysts. Both PCL tears and MRI findings suggestive of PCL mucoid degeneration show ligament thickening and increased PCL signal intensity. Tram-track PCLs are usually asymptomatic and typically have no ligamentous instability.
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de Abreu MR, Falcão M, Sprinz C, Furian R, Marczyk LR. Adhesive capsulitis of the knee. Skeletal Radiol 2013; 42:741-6. [PMID: 23436009 DOI: 10.1007/s00256-013-1582-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/07/2013] [Accepted: 01/13/2013] [Indexed: 02/02/2023]
Abstract
The authors describe the case of a 42-year-old woman presenting with significant knee pain and disability. Her imaging findings using contrast MR imaging and FDG PET/CT suggested adhesive capsulitis, which was confirmed by arthroscopy, histology, and the clinical outcome.
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Cha JR, Lee CC, Cho SD, Youm YS, Jung KH. Symptomatic mucoid degeneration of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2013; 21:658-63. [PMID: 22527411 DOI: 10.1007/s00167-012-1991-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 03/26/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The aim of this study was to detail the clinical, radiological, arthroscopic and pathological findings of this condition and to report clinical outcomes following arthroscopic partial excision of the ACL. METHODS Between 1999 and 2009, 80 knees in 78 patients were diagnosed as having mucoid degeneration of the ACL based on MRI and clinical findings, and subsequently underwent arthroscopic treatment. Of these, 68 knees in 66 patients, with a median age of 51 years (range, 35-75 years), were followed-up for at least one year. RESULTS All patients had insidious onset of knee pain, while 56 knees (82 %) had associated extension deficits and 36 knees (53 %) had restricted flexion. MRI findings typically showed diffuse thickening and increased signal intensity of the ACL. Arthroscopic examination revealed notch impingement and bulging of hypertrophied ACL into lateral compartments. Associated lesions included meniscal tears in 33 knees and chondral lesions of at least Outerbridge grade 2 in 56 knees. All knees underwent arthroscopic partial excision of the hypertrophied ACL, with three undergoing preoperative and 30 undergoing concomitant meniscectomies. Pain relief was achieved in 58 of 62 knees (94 %) following partial excision of the ACL. Extension deficits were normalized in 49 of 56 knees (88 %), and restricted flexion was normalized in 33 of 36 affected knees (92 %). Four knees of four patients had postoperative symptoms of anterior instability. CONCLUSIONS Pain and limitation of motion due to mucoid degeneration of the ACL can be improved by arthroscopic partial excision of the ACL with or without notchplasty. However, one potential complication is the development of postoperative symptoms of anterior instability. LEVEL OF EVIDENCE Retrospective study, Level IV.
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Affiliation(s)
- Jae-Ryong Cha
- Department of Orthopedic Surgery, Ulsan University Hospital, College of Medicine, Ulsan University, 290-3 Jeonha-dong, Dong-Gu, Ulsan, 682-714, South Korea
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Non-traumatic anterior cruciate ligament abnormalities and their relationship to osteoarthritis using morphological grading and cartilage T2 relaxation times: data from the Osteoarthritis Initiative (OAI). Skeletal Radiol 2012; 41:1435-43. [PMID: 22366737 PMCID: PMC3586320 DOI: 10.1007/s00256-012-1379-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this work was to study anterior cruciate ligament (ACL) degeneration in relation to MRI-based morphological knee abnormalities and cartilage T2 relaxation times in subjects with symptomatic osteoarthritis. METHODS Two radiologists screened the right knee MRI of 304 randomly selected participants in the Osteoarthritis Initiative cohort with symptomatic OA, for ACL abnormalities. Of the 52 knees with abnormalities, 28 had mucoid degeneration, 12 had partially torn ACLs, and 12 had completely torn ACLs. Fifty-three randomly selected subjects with normal ACLs served as controls. Morphological knee abnormalities were graded using the WORMS score. Cartilage was segmented and compartment-specific T2 values were calculated. RESULTS Compared to normal ACL knees, those with ACL abnormalities had a greater prevalence of, and more severe, cartilage, meniscal, bone marrow, subchondral cyst, and medial collateral ligament lesions (all p < 0.05). T2 measurements did not significantly differ by ACL status. CONCLUSIONS ACL abnormalities were associated with more severe degenerative changes, likely because of greater joint instability. T2 measurements may not be well suited to assess advanced cartilage degeneration.
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Kiekara T, Järvelä T, Huhtala H, Paakkala A. MRI of double-bundle ACL reconstruction: evaluation of graft findings. Skeletal Radiol 2012; 41:835-42. [PMID: 21959568 DOI: 10.1007/s00256-011-1285-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/25/2011] [Accepted: 09/12/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To demonstrate the magnetic resonance imaging (MRI) findings of double-bundle (DB) anterior cruciate ligament (ACL) reconstruction grafts. MATERIALS AND METHODS Sixty-six patients with DB ACL reconstruction were evaluated with MRI 2 years postoperatively. Graft thickness was measured separately by two musculoskeletal radiologists. The MRI findings of graft disruption, signal intensity (SI) changes, cystic degeneration, arthrofibrosis, and impingement were analyzed. The statistical significance of the association between MRI findings was calculated. RESULTS The mean anteromedial (AM) graft thickness was reduced 9% and the mean posterolateral (PL) graft thickness was reduced 18% from the original graft thickness. Disruption was seen in 3% of AM grafts and 6% of PL grafts and a partial tear in 8 and 23%, respectively. Both grafts were disrupted in 3% of patients. Increased SI was seen in 14% of intact AM grafts and in 60% of partially torn AM grafts (p = 0.032). In PL grafts the increased SI was seen in 51% of the intact grafts and in 93% of the partially torn grafts (p = 0.005). Cystic degeneration was seen in 8% of AM grafts and in 5% of PL grafts. Diffuse arthrofibrosis was seen in 5% of patients and a localized cyclops lesion in 3% of patients. Impingement of the AM graft was seen in 8% of patients. CONCLUSION Both grafts were disrupted in 3% of patients. Also, the frequencies of other complications were low. The use of orthogonal sequences in the evaluation of the PL graft SI seems to cause volume-averaging artefacts.
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Affiliation(s)
- Tommi Kiekara
- Medical Imaging Centre, Tampere University Hospital, FIN-33521, Tampere, Finland.
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Matrawy KA, El-Nekeidy AEAM, Al-Dawody A. Mucoid degeneration of the anterior cruciate ligament: frequently under-diagnosed entity in MRI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2012.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cho SD, Youm YS, Lee CC, Seo DK, Kim TW. Mucoid degeneration of both ACL and PCL. Clin Orthop Surg 2012; 4:167-70. [PMID: 22662304 PMCID: PMC3360191 DOI: 10.4055/cios.2012.4.2.167] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 02/08/2010] [Indexed: 11/29/2022] Open
Abstract
Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient's magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.
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Affiliation(s)
- Sung-Do Cho
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan University College of Medicine, Korea.
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Jung KH, Cho SD, Park KB, Youm YS. Relation between mucoid degeneration of the anterior cruciate ligament and posterior tibial slope. Arthroscopy 2012; 28:502-6. [PMID: 22265045 DOI: 10.1016/j.arthro.2011.08.315] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose was to analyze the association between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL). METHODS From October 1999 to May 2010, 84 arthroscopies were performed in 82 patients (18 men and 64 women) with mucoid degeneration of the ACL. The mean patient age was 53 years (range, 25 to 75 years). In addition to this patient group (group I), the study included a control group without mucoid degeneration of the ACL that was randomly matched for age, sex, body mass index, left or right side, and associated lesions (group II). For each group, the diagnosis was made by use of magnetic resonance imaging and arthroscopy, and a plain lateral radiograph was used to measure the PTS. RESULTS The mean PTS was 13.5° ± 2.6° (range, 8.2° to 19.5°) in group I and 9.4° ± 2.5° (range, 4.8° to 15.5°) in group II. The mean PTS in group I was significantly greater than that in group II (P < .001). For group I, the mean PTS of the involved knee was significantly greater than that of the uninvolved contralateral knee (P = .044). There were no differences according to age, sex, left or right side, body weight, and body mass index (P > .05). CONCLUSIONS Mucoid degeneration of the ACL was found to be associated with an increased PTS. The patients with mucoid degeneration of the ACL had a greater mean PTS than matched control patients (13.5° v. 9.4°, P < .001). LEVEL OF EVIDENCE Level III, diagnostic study of nonconsecutive patients without consistently applied gold standard.
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Affiliation(s)
- Kwang-Hwan Jung
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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Van Dyck P, De Smet E, Veryser J, Lambrecht V, Gielen JL, Vanhoenacker FM, Dossche L, Parizel PM. Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc 2012; 20:256-61. [PMID: 21773827 DOI: 10.1007/s00167-011-1617-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 07/05/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe rupture patterns of partial anterior cruciate ligament (ACL) tears on magnetic resonance (MR) imaging. METHODS MR images of 51 patients with a surgically confirmed partial ACL tear were retrospectively and independently interpreted by 2 experienced, blinded radiologists. Using previously described MR criteria, ACLs were categorized as follows: complete tear, partial tear, isolated anteromedial or posterolateral bundle tear, mucoid degeneration or normal ACL. MR interpretations were compared with the arthroscopic results as the standard of reference. Inter- and intraobserver agreements were determined using kappa (к) coefficients. RESULTS On MR imaging, ACL injuries were categorized as complete tears (16-23%), partial tears (20-47%), mucoid degeneration (12-27%) or normal ACLs (18-23%). Isolated ACL bundle tears were diagnosed on MR in 6% of our patients. Accuracy of MR for the diagnosis of partial ACL tears was 25-53%. Interobserver agreement was moderate (к = 0.48-0.56). Intraobserver agreement was good (к = 0.72-0.76). CONCLUSION MR diagnosis of a partial ACL tear is difficult because various tear patterns may be seen. Many partial tears demonstrate MR features that are indistinguishable from complete ACL tear, mucoid ACL degeneration or normal ACL. An isolated ACL bundle tear is infrequently detected on MR images.
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Affiliation(s)
- Pieter Van Dyck
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
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