Mucoïde degeneratie van de voorste kruisband als oorzaak van diepe kniepijn

2021 ◽  
Author(s):  
T. VINGERHOETS ◽  
S. CLAES ◽  
N. VAN BEEK
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Pain ◽  
Gold Standard ◽  
Cruciate Ligament ◽  
Mucoid Degeneration ◽  
Operative Outcomes ◽  
Voorste Kruisband ◽  
Anterior Cruciate ◽  
Posterior Knee ◽  
Femoral Notch

Mucoid degeneration of the anterior cruciate ligament: a little-known cause of deep knee pain Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known cause of deep atraumatic knee pain that is relatively frequent. Recent studies have reported a prevalence of 1,8-9,2% on MRI of the knee. Mucoid lesions consist of interstitial deposits of glycosaminoglycan between the collagen bundles. This causes hypertrophy of the ACL, which leads to mechanical impingement at the femoral notch, typically resulting in deep or posterior knee pain in terminal flexion and/or extension. Unlike the often-occurring traumatic ACL ruptures, there are no instability complaints. The gold standard for diagnosing mucoid degeneration of the ACL is MRI. This shows an abnormally thickened and ill-defined ACL with an increased intraligamentary signal on all sequences, but the orientation and continuity are usually maintained. Arthroscopically, the mucoid degeneration can be recognized by a hypertrophic ACL with yellowish to brown substances between the fibers. In addition, an absence of the synovial outline of the ACL is seen regularly. An arthroscopic partial or total ACL resection is the treatment of choice for symptomatic mucoid degeneration of the ACL and results in good post-operative outcomes without development of instability.

scholarly journals Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Koshiro Shimasaki ◽  
Tomokazu Yoshioka ◽  
Akihiro Kanamori ◽  
Masashi Yamazaki
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Case Reports ◽  
Cruciate Ligament ◽  
Proton Density ◽  
Valgus Knee ◽  
Mucoid Degeneration ◽  
Anterior Cruciate ◽  
Anterior Knee

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.

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

2018 ◽  
Vol 32 (06) ◽  
pp. 577-583 ◽  
Author(s):  
Andrew J. Hotchen ◽  
Charis Demetriou ◽  
Dennis Edwards ◽  
Joel T. K. Melton
Keyword(s):  
Outcome Measures ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Arthroscopic Debridement ◽  
Mucoid Degeneration ◽  
Notch Width ◽  
Anterior Cruciate ◽  
Posterior Knee ◽  
Notch Width Index

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

scholarly journals Lateral femoral notch sign and posterolateral tibial plateau fractures and their associated injuries in the setting of an anterior cruciate ligament rupture

2021 ◽  
Author(s):  
Alexander Korthaus ◽  
Malte Warncke ◽  
Geert Pagenstert ◽  
Matthias Krause ◽  
Karl-Heinz Frosch ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Ligament Injury ◽  
Ligament Rupture ◽  
Impression Fracture ◽  
Anterior Cruciate ◽  
Lateral Femoral Notch ◽  
Femoral Notch

Abstract Introduction ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral femoral notch sign and a posterolateral fracture of the tibial plateau are described. However, frequency, concomitant ligament injuries and when and how to treat these combined injuries are not clear. There is still a lack of understanding with which ligamentous concomitant injuries besides the anterior cruciate ligament injury these bony injuries are associated. Materials and methods One hundred fifteen MRI scans with proven anterior cruciate ligament rupture performed at our center were retrospectively evaluated for the presence of a meniscus, collateral ligament injury, a femoral impression, or a posterolateral impression fracture. Femoral impressions were described according to their local appearance and posterolateral tibial plateau fractures were described using the classification of Menzdorf et al. Results In 29 cases a significant impression in the lateral femoral condyle was detected. There was a significantly increased number of lateral meniscal (41.4% vs. 18.6% p = 0.023) and medial ligament (41.4% vs. 22.1%; p = 0.040) injuries in the group with a lateral femoral notch sign. 104 patients showed a posterolateral bone bruise or fracture of the tibial plateau. Seven of these required an intervention according to Menzdorf et al. In the group of anterior cruciate ligament injuries with posterolateral tibial plateau fracture significantly more lateral meniscus injuries were seen (p = 0.039). Conclusion In the preoperative planning of ACL rupture accompanied with a positive femoral notch sign, attention should be paid to possible medial collateral ligament and lateral meniscus injuries. As these are more likely to occur together. A posterolateral impression fracture of the tibial plateau is associated with an increased likelihood of the presence of a lateral meniscal injury. This must be considered in surgical therapy and planning and may be the indication for necessary early surgical treatment.

scholarly journals Clinical Outcomes of Arthroscopic Notchplasty and Partial Resection for Mucoid Degeneration of the Anterior Cruciate Ligament

2021 ◽  
Vol 10 (2) ◽  
pp. 315
Author(s):  
Joong Won Lee ◽  
Jung Tae Ahn ◽  
Hyun Gon Gwak ◽  
Sang Hak Lee
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Cruciate Ligament ◽  
Arthroscopic Surgery ◽  
Partial Resection ◽  
Knee Score ◽  
Mucoid Degeneration ◽  
Duration Of Symptoms ◽  
Significant Difference ◽  
Anterior Cruciate

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.

scholarly journals Effects of Distally Fixated Versus Nondistally Fixated Leg Extensor Resistance Training on Knee Pain in the Early Period After Anterior Cruciate Ligament Reconstruction

2002 ◽  
Vol 82 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Matthew C Morrissey ◽  
Wendy I Drechsler ◽  
Dylan Morrissey ◽  
Philippa R Knight ◽  
Paul W Armstrong ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Resistance Training ◽  
Acl Reconstruction ◽  
Knee Pain ◽  
Cruciate Ligament ◽  
Early Period ◽  
Kinetic Chain ◽  
Reconstruction Surgery ◽  
Open Kinetic Chain ◽  
Anterior Cruciate

Abstract Background and Purpose. Nondistally fixated (ie, what is often referred to as “open kinetic chain” [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called “closed kinetic chain” [CKC]) leg extensor training were compared for their effects on knee pain. Subjects. Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16–54). Methods. Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. Results. No differences in knee pain were found between the treatment groups. Discussion and Conclusion. Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

scholarly journals Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review

Cureus ◽  
2017 ◽  
Author(s):  
Raju Vaishya ◽  
Abdulrazaq Esin Issa ◽  
Amit Kumar Agarwal ◽  
Vipul Vijay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ganglion Cyst ◽  
Cruciate Ligament ◽  
Mucoid Degeneration ◽  
Anterior Cruciate
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