![]() ![]() Open Grey database was searched for grey literature using the same keywords. Keywords used for the Search were “mucoid degeneration”, “anterior cruciate ligament” and “ACL”. Three reviewers (an experienced librarian and two of the authors) independently searched these databases. MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus were comprehensively searched from the earliest year of indexing until 10 July 2020. This study was registered on PROSPERO, an international prospective register of systematic reviews (CRD42018087782). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. This study hypothesized that arthroscopic debridement of MDACL would provide patients with improvement in pain, range of movement and functional outcome scores. The purpose of this study was to investigate the outcome of management of MDACL by performing a systematic review of methods of treatment that have been reported. The success of treatment for MDACL and the subsequent risk of instability is not known. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Treatment for MDACL usually starts non-surgically with anti-inflammatory drugs and physiotherapy. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins. Arthroscopic diagnostic criteria are (1) continuous ACL fibres, (2) increased ACL volume, (3) yellowish-coloured material expressed on palpation and (4) loss of ACL synovial lining. have described the following MRI criteria : (1) high signal intensity in the T1 and T2 sequences, (2) increased ACL volume and (3) continuous fibres of ACL shown in the T2 sequence. MDACL is diagnosed by MRI, showing a celery stalk sign, and is confirmed by tissue biopsy and histological examination. Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension. However, MDACL is asymptomatic in most patients. The prevalence of MDACL on magnetic resonance imaging (MRI) ranges from 1.8 to 5.3%. MDACL is differentiated from synovial cysts of the anterior cruciate ligament (ACL) where, in MDACL, mucoid tissue intermingles within ACL fibres and is not contained within a cyst. Another theory is the “synovial theory” whereby a pouch of synovium herniates and is subsequently filled with synovium. The origin of MDACL may be degenerative or traumatic. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. ![]() The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. ConclusionsĪrthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. The mean MINORS score was 9.5 out of 16 (4–12). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. 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 pain relief ranged from 53.8 to 95%. The rate of simultaneous meniscectomy ranged from 13 to 44%. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). The mean follow up ranged from 13 to 72 months. A total of 313 knees in 292 patients were included. All nine studies assessed the outcome of arthroscopic debridement of MDACL. ResultsĪ total of nine studies were eligible for review. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. 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). MethodsĪ 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 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. ![]()
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