Reactive marrow edema (arrowheads) surrounds the intraosseous ganglia. The excised ACL tissue was sent for histopathological confirmation of mucoid degeneration. A painful injury where the upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues. Enter your email address below and we will send you the reset instructions. . This study showed that the patients who underwent debulking had statistically superior knee function, lesser rest pain and greater satisfaction rates at 2years of follow-up compared with those in whom MD-ACL was not debulked. Connect with thousands of patients and caregivers for support and answers. in this condition your acl (anterior cruciate ligament) filled with jelly like material and it thickened so space in intercondylar resion of knee joint is reduced. Correspondence to Google Scholar, Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. It can trap and damage the menisci in the knee and can also lead to early osteoarthritis. Proton density-weighted sagittal demonstrates a diffusely increased size of the ACL with ill-defined increased signal and interspersed intact ACL fibers. K Kunal: Substantial contributions to the conception, drafting the work, interpretation of data for the work, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work. Accessed Nov. 13, 2018. Cite this article. American Academy of Orthopaedic Surgeons. 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. Imagination. 1st ed. What is your diagnosis? In vivo elongation of the anterior cruciate ligament and posterior cruciate ligament during knee flexion. Let others know if this answer was helpful Main symptoms are pain during terminal knee flexion (as in squatting) feeling of heaviness/tiredness in the knee. For such patients, decompression of the ganglion at arthroscopy or via CT guidance is indicated and provides prompt relief.3,5,6. Skeletal Radiol 2001 Jun; 30(6): 312-5. This course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees. As we age, the connections between the collagen fibers that make up the meniscus begin to deteriorate, causing failure of the structure and tears due to stresses in the joint. In: Current Medical Diagnosis & Treatment 2019. CAS 6 Antonacci VP, Foster T, Fenlon H, Harper K, Eustace S: Technical report: CT-guided aspiration of anterior cruciate ligament ganglion cysts. A few studies have shown direct correlation between the presence of meniscus tear in patients with MD-ACL. The lesion may look like an elongated cyst along the long axis of the ACL, or as an enlarged ACL. What is mucoid degeneration of the meniscus? . mucoid degeneration acl symptoms. It can be secondary to trauma, or simply degeneration caused by meniscal injury, osteoarthritis or chondral damage [2]. Mucoid degeneration of the anterior cruciate ligament (ACL) is a common pathology but is often unknown and underdiagnosed. 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. These tests may include: Prompt first-aid care can reduce pain and swelling immediately after an injury to your knee. Patients will . Mucoid Degeneration of Posterior Cruciate Ligament Leads to Roof Impingement with Anterior Cruciate Ligament: Case Report. Anterior cruciate ligament (ACL) mucoid degeneration, along with tears and anterior cruciate ligament ganglion cysts, is a relatively common cause of increased signal within the anterior cruciate ligament (ACL ). Discrete intraosseous ganglia are observed in 3/4 of the cases with mucoid degeneration of the ACL. Treatment Notes prior to January 29, 2019 . Plain radiographs in lateral view (in standing) of the left knee of patient number 164 from group B (Left to Right): a Pre-operative radiograph for baseline position of posterior femur and tibia. Extraligamentous extension into the joint and intercondylar notch produces a higher incidence of mechanical symptoms (7a). Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. Which Teeth Are Normally Considered Anodontia. 1998-2023 Mayo Foundation for Medical Education and Research. [4]showed high percentages of laxity post debulking of MD-ACL, a finding which would not allow a surgeon to carry out a UKA after the debulking. It can be misdiagnosed a partial ACL tear. PubMed It included all patients who were diagnosed with mucoid degeneration of ACL and underwent mobile-bearing Oxford partial knee arthroplasty between January 2017 and February 2020, by consecutive sampling method. Furthermore, the ancillary MR findings of an ACL tear, such as bone bruises and the MR anterior drawer sign, are absent. A proton density-weighted coronal view from the same patient as seen in (A) and (B) reveals intraosseous ganglia (arrows) communicating with the ACL ganglion cyst (short arrow). statement and They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. https://doi.org/10.2214/ajr.182.5.18212835, Article Diagnosis is usually made on the MRI. [20], Chudasama etal. Make a donation. Histopathological confirmation of mucoid degeneration was obtained in all 442 patients. J Comput Assist Tomogr 1996 Jan-Feb; 20(1): 80-4. It can cause pain and to a meniscal tear. On longitudinal, intra-group comparison of the individual groups, it was noted that there was statistically significant (p<0.05) improvement in the ROM of patients who underwent debulking (Z-value: 13.047; p-value: 0.00) as well as no debulking group (Z-value: 9.990; p-value: 0.00) at 2years follow-up, compared with their individual pre-operative ROM. This allows the doctor to see the knee structures more clearly. Grade 1A laxity on Lachmans test (less than 5mm translation with a firm end-point) was noted in 27 knees (11.95%) intra-operatively in group B or those who underwent debulking (nb=226), whereas a firm endpoint with no translation was noted in all of the remaining 199 knees (88.05%). Mucoid degeneration of the ACL is a very rare cause of knee pain. Platelet-rich plasma (PRP) is known to influence musculoskeletal healing through multiple growth factors. 10, No. Freedom from war and natural disaster. With debulking of MD-ACL being a relatively newer concept and insufficient data backing the eventual stability of the ACL, the surgeons primarily performed UKA without debulking in MD-ACL, until December 2018. Get your query answered 24*7 only on | Practo Consult . Arthrosc Tech 7(5):e459e463. Conclusion: PRP can be used to improve the healing and strength ofa weakened ACL after partial debridement, but further research is needed to demonstrate its efficacy. Contact us. Anterior cruciate ligament injury. The stability measurements were subjective, and although undertaken by a blinded clinician, could be susceptible to human error. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p<0.05) as compared with their counterparts. 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 . Sequential intra-operative pictures (left to right): a Surgeon unable to pass the arthroscopy hook between the medial cortex of lateral femoral condyle and lateral border of mucoid ACL. There was a statistically significant improvement in the mean IKDC and mean KSS of both the groups at 2years of follow-up as compared with their pre-operative scores (p<0.05). strings of text saved by a browser on the user's device. Despite recent developments suggesting that debulking of MD-ACL does not cause instability [8], the involvement of another surgery that can directly be impacted by it complicates the decision making. Before an appointment, be prepared to answer the following questions: Mayo Clinic does not endorse companies or products. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Questions just answered: mucoid degeneration of acl physiotherapy. J Bone Jt Surg Br 73(4):582586. Clin Radiol. Background. Google Scholar, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Mucoid degeneration of anterior cruciate ligament (ACL) 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. Mucoid degeneration of anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a rare cause of knee pain in the middle-aged patient group, without knee instability. J Orthop Traumatol. https://doi.org/10.1177/03635465010290051301, Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. UKA by itself improves the functional and clinical outcome of patients with medial compartment osteoarthritis. https://doi.org/10.1016/j.knee.2020.06.004, Article Go to the Bones, Joints & Muscles Support Group. The time it takes to recover is approximately 3 months. 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 . All Rights Reserved. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Both the patient groups were matched for age, gender, pre-operative ROM and functional scores, minimising any confounding effect in data collection. The abnormal sliding within the knee also can hurt cartilage. Justamom21. Part of Is this likely to cause my knee pain or can it be the compressed lumbar nerve or both? [22]. : tissue degeneration marked by conversion of cell substance into a glutinous substance like mucus. : any of various mucoproteins that occur especially in secretions of mucous membranes. These patients who underwent UKA with debulking of MD-ACL were included in group B (nb=226). Hence, study objectives included determining the role and effects of debulking MD-ACL in a patient undergoing UKA as compared with those who do not undergo debulking, by clinical and functional analysis at 2years post-operatively. Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. Int J Curr Res Acad Rev 4(11):1824. Doctors and physical therapists will perform tests to gauge your knee's stability, strength, function and readiness to return to sports activities at various intervals during your rehabilitation. The samples collected from the five hospitals were 122 (group A: 58; group B: 64), 68 (group A: 35; group B: 33), 94 (group A: 46; group B: 48), 83 (group A: 41; group B: 42) and 75 (group A: 36; group B: 39), respectively. Predetermined inclusion and exclusion criteria were used for sample collection. Knee Surg Sports Traumatol Arthrosc 21(3):658663. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). [21] and Ventura etal. They were however, supplemented by other objective methods such as comparison of pre-operative, post-operative and follow-up status of lateral view of plain radiograph in standing position, to look for any posterior translation of the femur which would suggest instability. It is characterised by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the substance of ACL leading to thickening of the native ACL and its impingement on the lateral femoral condyle, femoral notch and PCL, consequently causing knee pain and limited motion. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 3 Do-Dai DD, Youngberg RA, Lanchbury FD, et al: Intraligamentous ganglion cysts of the anterior cruciate ligament: MR findings with clinical and arthroscopic correlations. Physiotherapy. An interesting feature of cruciate ganglia, which has not been widely reported, is their tendency to extend into adjacent intra-articular spaces and osseous structures. There's no set time frame for athletes to return to play. Google Scholar, White SH, Ludkowski PF, Goodfellow JW (1991) Anteromedial osteoarthritis of the knee. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. -Evaluated and planned treatment protocol in accordance with physician. Feb 17, 2023 7:27 AM. Without a properly functioning ACL, the other structures of the knee experience greater strain, which causes further injuries to tissues in the knee. A longer recovery period may reduce the risk of re-injury. Another theory states that it is a consequence of herniation of a synovial pouch in the substance of the anterior cruciate ligament (ACL), and the subsequent synovial filling inside it; however, the major aetiology of MD-ACL still remains an enigma [4]. 2023 BioMed Central Ltd unless otherwise stated. Treatment is only required if there are otherwise unexplained symptoms. Anterior Cruciate Ligament, is an important structure of the knee joint. 373) A September 2018 MRI of the left knee showed anterior cruciate ligament and mucoid degeneration with intra cruciate ganglion and pericruciate synovitis . It can cause pain and to a meniscal tear. The severity of the ACL injury is graded from 1 to 3. With the advent of the mobile-bearing UKA system, the predilection towards this surgery is on an upward trend. As per study population statistics, the prevalence of medial meniscus tears (29.64%) in this study were congruent to the rates found in studies by Srivastava etal. Mucoid degeneration of the anterior cruciate ligament, International Knee Documentation Committee, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK (1999) Mucoid cystic degeneration of the cruciate ligament. Correlation with operation methods in 200 knees. Two characteristic MR appearances have been described for ganglion cysts of the ACL. Arthroscopic debridement may help relieve the anterior knee pain. Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. Indian J Orthop 46(5):561565. (i.e., thinning or thickening) or signs of ligament degeneration and attrition such as mucoid degeneration or sclerosis were absent in all specimens. Ventura etal. . Do you ever feel that your knee is unstable or unable to support your weight? Informed written consent was obtained from all patients. Pre-operative and follow-up lateral radiographs of the patients who underwent debulking were analysed by a blinded radiologist and no posterior translation of the femur was noted, thereby confirming no instability caused by the debulking (Fig. Grade 1: The ligament is intact, and the joint is stable, but there is minimal stretching and some microscopic tearing of the ACL. Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study, https://doi.org/10.1186/s43019-022-00169-9, https://doi.org/10.1302/0301-620X.81B2.0810304, https://doi.org/10.2214/ajr.182.5.18212835, https://doi.org/10.1007/s00167-011-1433-0, https://doi.org/10.1007/s00167-012-1991-9, https://doi.org/10.1186/s43019-021-00110-6, https://doi.org/10.1016/j.knee.2020.06.004, https://doi.org/10.1302/0301-620X.73B4.2071640, https://doi.org/10.1016/j.knee.2010.05.003, https://doi.org/10.3109/17453679209154722, https://doi.org/10.1302/0301-620X.93B4.25562, https://doi.org/10.1186/s10195-020-00551-x, https://doi.org/10.1177/03635465010290051301, https://doi.org/10.1016/j.eats.2017.11.006, https://doi.org/10.20546/ijcrar.2016.411.003, https://doi.org/10.4055/cios.2018.10.3.307, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. This site complies with the HONcode standard for trustworthy health information: verify here. Pre-operatively, patients were examined and clinicoradiologically confirmed for MD-ACL and medial compartment osteoarthritis (MCOA) of the affected knee. It's a site that collects all the most frequently asked questions and answers, so you don't have to spend hours on searching anywhere else. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. Notchplasty is an ancillary surgical procedure that consists of reshaping and widening of the intercondylar femoral notch, historically developed and performed with the aim to avoid ACL graft impingement and improve visualization of the lateral wall of the femoral notch during ACLR surgery. 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. It can be misdiagnosed a partial ACL tear. . Sigmund Freud emphasized the importance of the unconscious mind, and a primary assumption of Freudian theory is that the unconscious mind governs behavior to a greater degree than people suspect.Indeed, the goal of psychoanalysis is to make the unconscious conscious. PubMed Central https://doi.org/10.4103/0019-5413.128765, Article It is postulated that intraosseous extension may be a finding more often associated with pain (8a). They cross each other to form an X with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The portal can access those files and use them to remember the user's data, such as their chosen settings (screen view, interface language, etc. Mucinous material within the substance of ACL produces pain and limited motion in the knee. You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting, More than one ligament or the fibrous cartilage in your knee also is injured, The injury is causing your knee to buckle during everyday activities. It results in postoperative laxity, but rarely in frank instability. Follow us on social media for the latest updates, Future Medicine Ltd, Unitec House, 2 Albert Place, London, N3 1QB, UK, We use cookies to improve your experience. Am J . 58th ed. (Table 2). Mucoid degeneration of the anterior cruciate ligament (ACL) is a clinical condition observed primarily in middle-aged patients presenting with knee pain and limited range of motion in the absence of symptoms of instability or a significant history of trauma [].ACL mucoid degeneration causes knee pain less frequently than meniscal tears or chondral defects [17, 18] and has been rarely reported . Most older patients with meniscus tears can obtain relief from symptoms such as pain, swelling and decreased range of motion, and improve function, without surgery. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients.Materials and MethodsBetween December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis . cystic degeneration degeneration with formation of cysts. What is one assumption of Freud's psychoanalytic theory? Signs and symptoms: It usually affects middle aged and elderly people. Among other conditions - osteoarthritis, osteopenia, spondylolisthesis- an MRI report showed "severe mucoid degeneration of the ACL" in my left knee. Often the diagnosis can be made on the basis of the physical exam . Injury prevention. An ACL sprain is when the ACL is overstretched (but not torn). This was confirmed at 2years follow-up, when the patients who underwent debulking showed a statistically significant improvement in in mean terminal flexion by 21.51 in group B (mean pre-operative: 96.3855.78; mean post-operative: 117.892.64) as compared with 5.02 in group A (mean pre-operative: 98.0934.79; mean post-operative: 103.114.1). Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Anterior cruciate ligament (ACL) injury.Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. (4a) 3D rendering of an ACL ganglion viewed from the medial side with the medial femoral condyle removed. Terms and Conditions, The patients clinical history and symptoms do not support an ACL injury. Despite integrity and status of cruciates being paramount in a UKA, no study has evaluated the effect of debulking MD-ACL in this procedure. Int J Sports Phys Ther 10(1):5261, PubMed Hence, the improvement in ROM, attenuation of rest pain and better long term functional outcome measures supported the hypothesis regarding the positive effect of debulking a MD-ACL in patients undergoing UKA. Arthroscopic surgeries are key hole surgeries for joint disorders. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee. model of self-care at home: Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. After collecting their demographic details, the ROM of the affected knee was noted, following which they were planned for surgery in the form of mobile-bearing UKA. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Sagittal T1-weighted (1a) and fat-suppressed proton density-weighted (1b) images. This was postulated to be due to the increased tension caused by the mucinous deposition in the substance of the ACL, leading to irritation of the native nociceptors of the tendon and the consequent impingement on the lateral femoral condyle, femoral notch and posterior cruciate ligament (PCL) owing to the increased thickness of the ACL [6,7,8]. Google Scholar, Cha JR, Lee CC, Cho SD, Youm YS, Jung KH (2013) Symptomatic mucoid degeneration of the anterior cruciate ligament. A surgical procedure that involves replacing a damaged, worn or diseased knee with an artificial joint to restore knees movement. The demographic data of the study population is presented in Table 1. 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. Instrumental treatment. All 5 patients under- went arthroscopic surgery. [] found the incidence of mucoid degeneration in their study population to be 1.0%.Most of their reported cases were incidental findings without contributory symptoms. Mucoid degeneration of ACL. Return to play following anterior cruciate ligament reconstruction. In these patients, when UKA is coupled with debulking of the MD-ACL with a predetermined end point, a significant improvement in the overall ROM, rest pain, functional outcome scores and subjective satisfaction of the patient can be achieved. Autologous PRP, prepared by double spin protocol, was injected into the remaining ACL after partial debridement was done. The left ureter was normal in the pelvis. A physical therapist will teach you exercises that you will perform either with continued supervision or at home. Mucoid degeneration of ACl is a rare pathological process involving knee joint. Background: There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). It may lead to knee pain. Score: 4.7/5 (45 votes) . (6a) "Celery stalk" form of ACL ganglion cyst. Physical therapy typically begins 7-10 days after the procedure. TimesMojo is a social question-and-answer website where you can get all the answers to your questions. c End-point of debulking when the surgeon can pass the arthroscopy hook between the medial cortex of lateral femoral condyle and lateral border of the native ACL effortlessly. PubMed Central Clinical History: 37 year-old male with no known injury, complaining of diffuse knee pain and stiffness, worsening over the last 3 months. How long does it take an ACL to heal without surgery? 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. The appearance can mimic acute or chronic interstitial partial tears of the ACL. Knee 18(3):168171. https://doi.org/10.1186/s10195-020-00551-x, Mulligan EP, McGuffie DQ, Coyner K, Khazzam M (2015) The reliability and diagnostic accuracy of assessing the translation endpoint during the lachman test. https://doi.org/10.1302/0301-620X.81B2.0810304, Article The position of the femoral tunnel is important in graft isometry, permitting constant tension of the graft throughout the range of motion of the knee. Mucoid Degeneration of Posterior Cruciate Ligament Leads to Roof Impingement with Anterior Cruciate Ligament: Case Report. Anatomy. The purpose of this study was to diagnose mucoid degeneration of ACL and to assess the effectiveness of arthroscopic treatment in these patients. . Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. However, all of these debridements were done under arthroscopy, whereas the surgeons in this study progressively debulked the ACL by open method using a 15-number blade, under direct vision. (2a) T1-weighted sagittal image demonstrates an enlarged, club-shaped anterior cruciate ligament (arrows). J Comput Assist Tomogr 1996 Jan-Feb; 20(1): 80-4. All authors read and approved the final manuscript. 2). J Bone Jt Surg [Br] 68-B:608609, Kang SN, Smith TO, De Rover WBS, Walton NP (2011) Pre-operative patellofemoral degenerative changes do not affect the outcome after medial Oxford unicompartmental knee replacement: a report from an independent centre. PubMed Central . Besides, the patient may also have trouble in moving. strings of text saved by a browser on the user's device. Diagnosis. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is commonly treated with arthroscopic debridement of the ACL. These findings were in line with the findings published by Cha etal. Provided by the Springer Nature SharedIt content-sharing initiative. PubMed Details on the top journals, universities, and authors on t. Papadakis MA, et al., eds. My MRI done in June states that I have very severe mucoid degeneration/partial thickness tearing of the ACL with the tibial spine tractional marrow edema. I know what the words mean. Purpo. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. The MR-findings of mucoid degeneration of the ACL include: an ill-defined ACL; an increased ligamentous girth But many studies have reported the weakening and laxity of ACL postoperatively and on follow-up. Subsequently, controlled debulking of the posterolateral fibers was done using a 15-number blade until it was possible to tug at the ACL by passing a hook between the lateral femoral condyle and the posterolateral fibres of the ACL (Fig. The treatment alternatives, indications for the planned procedure and risks were discussed with her in detail and an informed consent was obtained. Not really known: Mucoid degeneration of the ACL is seen most commonly in adults (35-55 years of age). The anterior cruciate ligament (ACL) is an important ligament in the knee. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. At the time of the injury, a "pop" or "snap . 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