Due to the heterogeneity of data, a meta-analysis was not possible, and a narrative review was deemed most appropriate. The site is secure. 2011;19(3):408411. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased signal intensity and a celery stalk appearance of intact fibers. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Its interstitial nature within the ACL structure contrasts with synovial cyst of the ACL. Disclaimer. Postoperative ACL laxity is a common finding after ACL arthroscopic debridement, however, symptomatic instability is not. 1. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. Unauthorized use of these marks is strictly prohibited. Knee Surg Sports Traumatol Arthrosc 19(8):13261333. Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. J Int Med Res. Pandey, Vivek et al. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist [9]. Introduction: Discussion: what causes mucoid degeneration of acl. Keywords: The clinical presentation is one of posterior pain with limited flexion. HHS Vulnerability Disclosure, Help Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. Results: Disclaimer. Methods: The minimum follow-up was 3 years. Knee Surg Sports Traumatol Arthrosc. 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. Later studies reported that changes consist of mucoid Results degeneration, neovascularisation, and tendon sheath hyper- Nineteen patients met the inclusion criteria and were inclu- trophy. 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 and if this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings. J Arthrosc Joint Surg 3(1):2833. https://doi.org/10.1016/j.arthro.2003.11.030, Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. . eCollection 2022 May-Jun. 2011. MM and A performed the literature search, and data analysis. Accessibility 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. PMC Federal government websites often end in .gov or .mil. That is usually the journal article where the information was first stated. 2018 Sep;10(3):307-314. doi: 10.4055/cios.2018.10.3.307. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. volume33, Articlenumber:26 (2021) Keywords: mucoid degeneration, anterior cruciate ligament, acl reconstruction, arthroscopy, knee in 1999 [ 1 ]. Clipboard, Search History, and several other advanced features are temporarily unavailable. ADVERTISEMENT: Supporters see fewer/no ads. mucoid degeneration acl symptoms. Arthroscopic debridement may help relieve the anterior knee pain. Mucoid degeneration of acl (anterior cruciate ligament) is not a common problem and mostly it is found in female patients. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. 2022 Jun 2;20(1):225-228. doi: 10.33314/jnhrc.v20i01.4182. Arthroscopy. Knee Surg Sports Traumatol Arthrosc 21(3):658663. Epub 2010 May 8. 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 [3]. Physiotherapy. Mucoid degeneration of ACL is a disease affecting ACL in which mucoid like substance (glycosaminoglycans) gets interspersed within the substance of ACL and as a result ACL gets thickened. Case report: Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. Any discrepancy was resolved by the senior author. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. 8600 Rockville Pike Orthop Traumatol Surg Res 96(4):400406, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Online ahead of print. mucoid degeneration of acl mri. 2013 Oct;99(6):693-7. doi: 10.1016/j.otsr.2013.04.010. Twelve partial and 17 total resections were performed. Method. J Bone Joint Surg Ser B 81(2):304305. did not report on this. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. [Diagnosis and treatment of anterior cruciate ligament cysts]. Ligaments are very tough, fibrous tissue structures. Cookies policy. and transmitted securely. ACL mucoid degeneration is present on ~10% (range 9-12%) of 3 T MRI examinations and 2% of 1.5 T MRI examinations 6. Clinical Outcomes, Return to Sports, and Patient Satisfaction After Anterior Cruciate Ligament Reconstruction in Young and Middle-Aged Patients in an Asian Population-A 2-Year Follow-up Study. A long duration of non-specific knee pain in a patient should be evaluated with MRI. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Cho SD, Youm YS, Lee CC et-al. Orthopaedics & Traumatology: Surgery & Research. Data extracted included mean age and gender of the patients, duration of follow up, associated chondral and meniscal lesions, interventions and outcomes. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. Arthroscopy. . J Chin Med Assoc. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. An official website of the United States government. National Library of Medicine . They respond well to a judicious arthroscopic release of the ACL with notchplasty. The site is secure. 2013;15(1). There was strong association between degenerative changes and MDACL (82% having chondral and 69% meniscal lesions), which might suggest that MDACL is a degenerative process. This makes it difficult to relate the improvement of symptoms to ACL debridement. TS designed the project, literature search and wrote the manuscript. reported the largest percentage of patients (27.5%) with a positive pivot test. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. There is no consensus on treatment and evidence is scarce. After the literature search and exclusion of duplicates, 54 papers were retrieved: 12 articles were assessed for eligibility, and of these, 9 papers met the inclusion criteria and were included in the systematic review [3, 6, 13,14,15,16,17,18,19] (Fig. HHS Vulnerability Disclosure, Help 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). They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. Online ahead of print. It is lined by the synovial fluid, which provides the nutrition and plays an integral part in healing. Pre-debridement arthroscopic view showing yellowish content in the anterior cruciate ligament. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. Partial/Total ACL resection arthroscopically- There is marked improvement in the range and reduced posterior pain, but at the cost of increased post-operative knee laxity. Four studies reported only postoperative scores, which were comparable to those in other studies. Ventura et al. 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. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. 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. The author(s) read and approved the final manuscript. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. 2006;69(9):44952. Before The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. Sometimes, it is mislead as ACL tear on MRI findings, hence requires probing and histopathology for definitive diagnosis. You can read more if you want. Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. : A Meta-Analysis. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. Characteristic: "celery stalk" appearance. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Anterior Cruciate Ligament, is an important structure of the knee joint. Epub 2013 Aug 27. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Level of Evidence: Level IV. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. This site needs JavaScript to work properly. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Roberts D, Saber M, et al. Each study was scored 02 on each question, with a global ideal score of 16. reported on the co-existence of mucoid degeneration and ganglia of the ACL. the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. The pathogenesis remains controversial. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. and Ventura et al. Postoperative clinical laxity was common, however, symptomatic instability was not. Eight studies reported postoperative instability. Epidemiology The likelihood of mucoid change within ligaments and tendons increases with age 1. It is a chronic degenerative change of a bulky ACL that may lead to notch . The retrospective study by Kim et al. Physical therapy typically begins 7-10 days after the procedure. Please enable it to take advantage of the complete set of features! Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. 2019 Jun;32(6):577-583. doi: 10.1055/s-0038-1660514. (61years), which was the largest study and represented more than one third of the total patients included in this review. AJR Am J Roentgenol. CAS 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Study record managers: refer to the Data Element Definitions if submitting registration or results information.. Search for terms Average improvement in flexion was 21.5 degrees (0 to 60 degrees). The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Surgical treatment involves arthroscopic debridement of ACL, with partial or total resection, occasionally combined with ACL reconstruction. Epub 2021 Mar 8. It has recently been postulated that mucoid degeneration of the ACL is related to the medial knee compartment joint space loss in patients with osteoarthritis or in the OA risk group 6. With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. 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). Would you like email updates of new search results? 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. Epub 2018 Jan 2. The https:// ensures that you are connecting to the Mucoid degeneration of the anterior cruciate ligament (ACL) of the knee can cause knee pain and other symptoms. https://doi.org/10.1302/0301-620X.81B2.0810304, Article Reeducation. Mumbai, Maharashtra, India. 2018. http://journals.sagepub.com/doi/10.1177/2325967118786930, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. 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. proposed reduction plasty, which is reduction of the ACL to normal volume without excision of all mucoid tissue. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Histologically, there is a mucoid substance in connective tissue containing glycoproteins and mucoproteins [8]. Chudasama CH, Chudasama VC, Prabhakar MM. Score: 4.7/5 (45 votes) . The appearance can mimic acute or chronic interstitial partial tears of the ACL. 2001;30(6):312315. Knee Surg Sports Traumatol Arthrosc. The mean follow up ranged from 13 to 72months. Epub 2013 Aug 27. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Bergin et al. This was lowest in the study of Cha et al. PubMed What causes mucoid degeneration of ACL? Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. Arch Orthop Trauma Surg. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Cite this article. Bethesda, MD 20894, Web Policies https://doi.org/10.4103/0019-5413.101037, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligament management and functional outcome of 18 cases. 1. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Level of evidence: report that one patient had ACL reconstruction simultaneously after the ACL debridement. Hamal B, Karmacharya M, Mangal Joshi K, Gorkhali R. J Nepal Health Res Counc. Epub 2010 May 8. 2022 Nov 24. doi: 10.1007/s00402-022-04659-z. All patients (100%, n=11) reported a good to very good surgery satisfaction. Multiple theories have been put forth that explains the pathological disorganization in the collagen fibers of the Anterior Cruciate Ligament, such as synovial, traumatic, and degenerative, "Synovial theory- states that there is accumulation of synovial fluid inside the substance of ACL in a herniated pouch of synovium. Clinical outcome was reported using a variety of scores (the Lysholm and International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the visual analogue scale (VAS) score) in the different studies; these are summarized in Table 4. Clipboard, Search History, and several other advanced features are temporarily unavailable. Finally, partial meniscectomy was commonly performed simultaneously with ACL debridement in all studies, which arguably could be the reason for the postoperative improvement. Fourteen knees (48%) had limited flexion, on average 97 degrees. 2004;182 (5): 1283-7. I get PT and acupuncture, have had several epidural injections, and am trying hard to avoid osteoporosis meds (was on bisphosphonates for many years many years ago) as well as spinal fusion. 2011. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. All nine studies were case series; six were retrospective and three were prospective studies. Tamer Sweed. Unable to load your collection due to an error, Unable to load your delegates due to an error. Advanced MR imaging of the cruciate ligaments. 6. #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #orthopaedic #painphysician #physiotherapy #sportsmed #orthopaedic #mskmri. In these studies, the total number of patients with a postoperative positive Lachman test was 40% (77 of 194 patients). MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. Unable to process the form. Knee Surg Sports Traumatol Arthrosc. PMC Roberts CC, Towers JD, Spangehl MJ et-al. statement and Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Mucoid degeneration, is the irreversible degeneration of the tissue with the infiltration of mucin(glycosaminoglycans) within the fibers[1][2]. Mucoid degeneration of the anterior cruciate ligament (MD-ACL) was first characterized by Kumar et al. Mucoid degeneration,: like degenerative arthritis of a joint, generally occurs as a results of aging. -, Hensen JJ, Coerkamp EG, Bloem JL, De Schepper AM. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-3615, Case 11: with Hoffa fat pad ganglion cyst, Case 12: tibial nerve schwannoma and ACL mucoid degeneration, Case 1: Complete ACL tear and meniscal tears, Case 2: Anomalous insertion of the medial meniscus, View Frank Gaillard's current disclosures, see full revision history and disclosures, anterior cruciate ligament ganglion cysts, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Mucoid degeneration of the anterior cruciate ligament, congenital or acquired synovial tissue entrapment between ACL fibers. (100%). 2. Symptomatic ACL mucoid degeneration in middle-age athletes. Conclusions: Mucoid degeneration of the ACL is a clinical condition afflicting active middle-aged people without a single significant traumatic episode with a specific MRI picture. All patients (100%, n=11) reported an improvement in pain. Mucoid degeneration of A C L is more common and literature has also reported many cases, but for PCL only few cases have been reported in English literature. Knee Surg & Relat Res 33, 26 (2021). The clinical presentation is one of posterior pain with limited flexion. Bethesda, MD 20894, Web Policies Anterior cruciate ligament; Arthroscopy; Knee; Mucoid degeneration. Intact fibers are best seen on T2WI. Other theories include Degenerative theory- MD could occur due to ageing.[3]. sharing sensitive information, make sure youre on a federal The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 8600 Rockville Pike If arthroscopy is performed, the ligament may appear entirely normal, especially using the standard anterior portal approach. National Library of Medicine The origin of MDACL may be degenerative or traumatic. ANZ J Surg 73(9):712716. Skelet Radiol 30(6):312315. Google Scholar, Chudasama CH, Chudasama VC, Prabhakar MM (2012) Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Before Knee Surg Sports Traumatol Arthrosc. An official website of the United States government. J Orthop. . Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. The mean MINORS score was 9.5 (range 412). Mucoid degeneration of the anterior cruciate ligament. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. 2011. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Pan Afr Med J. Its function is to stabilize the knee while bending and rotating; the ACL also keeps the knee from shifting out of place or moving anteriorly (toward the front) with pivoting activities. Here are the search results of the thread mucoid degeneration of acl treatment from Bing. 2011 Aug;19(8):1326-33. doi: 10.1007/s00167-011-1433-0. Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. Mucoid degeneration of the anterior cruciate ligament (ACL) is regarded as a degenerative change in the ligament, which is clinically presented with pain on full extension or flexion in the middle-aged population. Part of Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Along with that, it also controls the internal rotation. We report a case of mucoid degeneration of the ACL in a 50-year-old female with knee pain of 18 months duration. Glossary of terms for musculoskeletal radiology. Conclusion: This is a rare pathological condition, in which, there is increased signal from within the ligament. official website and that any information you provide is encrypted See this image and copyright information in PMC. The https:// ensures that you are connecting to the The extracted data were heterogeneous in terms of outcome assessment. . The knee is a complex synovial joint that can be affected by a range of pathologies: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The minimum follow-up was 3 years. Introduction: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. These appearances must be differentiated from mucoid degeneration of the intact ACL. Results: https://doi.org/10.4103/0019-5413.128765, Article The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Bookshelf Knee Surg Sports Traumatol Arthrosc. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. The primary intervention was arthroscopic ACL debridement in eight studies; this was combined with notchplasty in cases of impingement with the lateral wall of the notch in five studies [6, 14, 16,17,18] (Table 3). 2011. All nine studies assessed the outcome of arthroscopic debridement of MDACL. sharing sensitive information, make sure youre on a federal Careers. Questions just answered: mucoid degeneration of acl physiotherapy. https://www.physio-pedia.com/index.php?title=Anterior_Cruciate_Ligament_(ACL)_Mucoid_Degeneration&oldid=253974, Difficulty in climbing stairs, cross-leg sitting, squatting, Primary condition- Osteoarthritis, degenerative menisci, meniscal tear, Impingement of the soft tissue in the vicinity. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review, https://doi.org/10.1186/s43019-021-00110-6, https://doi.org/10.1302/0301-620X.81B2.0810304, https://doi.org/10.1007/s00167-011-1433-0, https://doi.org/10.2214/ajr.182.5.1821283, https://doi.org/10.1007/s00167-012-1991-9, https://doi.org/10.1016/j.arthro.2003.11.030, https://doi.org/10.1016/j.jclinepi.2009.06.005, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782, https://doi.org/10.1046/j.1445-2197.2003.02748.x, http://journals.sagepub.com/doi/10.1177/2325967118786930, http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, https://doi.org/10.1016/j.arthro.2008.02.004, https://doi.org/10.1016/j.jajs.2015.12.001, https://doi.org/10.4055/cios.2018.10.3.307, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. . J Chin Med Assoc. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. 2004;182(5):12831287. Magn Reson Imaging Clin N Am. 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. (B) Partial resection, MeSH The appearance can mimic acute or chronic interstitial partial tears of the ACL. Hide glossary Glossary. Average postoperative differential laxity on the Telos device was 8.3 mm (5 to 13 mm). https://doi.org/10.1016/j.jajs.2015.12.001, Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J (2018) Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. Khanna et al. Second, methodological quality assessment showed that three studies had low methodological quality. [3] and in 1% of patients (3 of 106 knees) in the study of Kim et al. However, the authors did not report whether there were any other patients with symptomatic instability. The inclusion criteria for this study were (1) studies including symptomatic patients with mucoid degeneration of the ACL, (2) studies of 10 or more patients, (3) a minimum of 6months follow up and (4) patients treated conservatively or surgically (arthroscopic debridement with or without simultaneous ACL reconstruction). 2001;17(9):E37. J Orthop. Indian J Orthop. Both anterior cruciate ligament ganglion cysts and mucoid degeneration have a high association with intraosseous cysts [3] (figures 1 and 2). Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al.