Download PDF
The Journal of Knee Surgery Reports 2015; 1(01): 025-030
DOI: 10.1055/s-0034-1399759
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bony Erosion with Mucoid Degeneration of the Anterior Cruciate Ligament

Yusuke Ueda
1   Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, School of Medicine, Saitama, Japan
,
Kazuo Saita
1   Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, School of Medicine, Saitama, Japan
,
Takehiko Yamaguchi
2   Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya-shi, Saitama, Japan
,
Hitoshi Sekiya
3   Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Toru Akiyama
1   Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, School of Medicine, Saitama, Japan
› Author Affiliations
Further Information

Publication History

11 November 2013

27 September 2014

Publication Date:
12 January 2015 (online)

   Permissions and Reprints

Abstract

Mucoid degeneration of the anterior cruciate ligament (MDACL) is a comparatively rare pathological finding in clinical practice. Its pathophysiology is still unclear. MDACL can be suspected in patients with knee pain associated with a thickened ACL. Treatment involving arthroscopic resection of the yellow mucoid substance is efficient for relieving the symptoms. Only few reports had mentioned about the association with the erosion of adjacent bone. Here, we describe the cases of our two MDACL patients with osseous erosion. Both the patients had suffered from posterior knee pain for several months. Magnetic resonance imaging (MRI) indicated a thickened ACL with increased signal with bone erosion on T2-weighted images. On arthroscopy, the ACLs were found to be grossly hypertrophied, and the region of the posterolateral bundle was impinged in both the patients. No bony pathological findings were observed by arthroscopy. The yellowish degenerated portion of the ACL was resected to resolve the pathological situation in each case. Postoperatively, both the patients had a full range of painless motion with no impediments to the quick resumption of daily living. Follow-up MRIs showed reduced volumes of bone erosion. Thus, bone erosion was not the main cause of the knee pain, but rather was a lesion associated with MDACL.

Keywords

knee - anterior cruciate ligament - mucoid degeneration - bone erosion
 

  • References

  • 1 Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid cystic degeneration of the cruciate ligament. J Bone Joint Surg Br 1999; 81 (2) 304-305
    CrossrefPubMedGoogle Scholar
  • 2 Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. AJR Am J Roentgenol 2004; 182 (5) 1283-1287
    CrossrefPubMedGoogle Scholar
  • 3 Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C. Mucoid metaplastic-degeneration of anterior cruciate ligament. J Sports Med Phys Fitness 2008; 48 (4) 483-487
    PubMedGoogle Scholar
  • 4 Motmans R, Verheyden F. Mucoid degeneration of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2009; 17 (7) 737-740
    CrossrefPubMedGoogle Scholar
  • 5 Melloni P, Valls R, Yuguero M, Sáez A. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle. Skeletal Radiol 2004; 33 (6) 359-362
    CrossrefPubMedGoogle Scholar
  • 6 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedGoogle Scholar
  • 7 Mitsou A, Vallianatos P, Piskopakis N, Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br 1990; 72 (3) 398-404
    PubMedGoogle Scholar
  • 8 Hoshino Y, Kuroda R, Nagamune K , et al. In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med 2007; 35 (7) 1098-1104
    CrossrefPubMedGoogle Scholar
  • 9 Daniel DM, Stone ML, Sachs R, Malcom L. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 1985; 13 (6) 401-407
    CrossrefPubMedGoogle Scholar
  • 10 Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Knee Surg Sports Traumatol Arthrosc 2011; 19 (8) 1326-1333
    CrossrefPubMedGoogle Scholar
  • 11 Fernandes JL, Viana SL, Mendonça JL , et al. Mucoid degeneration of the anterior cruciate ligament: magnetic resonance imaging findings of an underdiagnosed entity. Acta Radiol 2008; 49 (1) 75-79
    CrossrefPubMedGoogle Scholar
  • 12 Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Orthop Traumatol Surg Res 2010; 96 (4) 400-406
    CrossrefPubMedGoogle Scholar
  • 13 Narvekar A, Gajjar S. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2004; 20 (2) 141-146
    CrossrefPubMedGoogle Scholar
  • 14 Hsu CJ, Wang SC, Fong YC, Huang CY, Chiang IP, Hsu HC. Mucoid degeneration of the anterior cruciate ligament. J Chin Med Assoc 2006; 69 (9) 449-452
    CrossrefPubMedGoogle Scholar
  • 15 Cha JH, Lee SH, Shin MJ, Choi BK, Bin SI. Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation. Skeletal Radiol 2008; 37 (9) 821-826
    CrossrefPubMedGoogle Scholar
  • 16 Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Arthroscopy 2008; 24 (6) 642-649
    CrossrefPubMedGoogle Scholar
  • 17 Muir P, Schamberger GM, Manley PA, Hao Z. Localization of cathepsin K and tartrate-resistant acid phosphatase in synovium and cranial cruciate ligament in dogs with cruciate disease. Vet Surg 2005; 34 (3) 239-246
    CrossrefPubMedGoogle Scholar
  • 18 Barrett JG, Hao Z, Graf BK, Kaplan LD, Heiner JP, Muir P. Inflammatory changes in ruptured canine cranial and human anterior cruciate ligaments. Am J Vet Res 2005; 66 (12) 2073-2080
    CrossrefPubMedGoogle Scholar
  • 19 Akiyama T, Bouillet P, Miyazaki T , et al. Regulation of osteoclast apoptosis by ubiquitylation of proapoptotic BH3-only Bcl-2 family member Bim. EMBO J 2003; 22 (24) 6653-6664
    CrossrefPubMedGoogle Scholar
  • 20 Akiyama T, Dass CR, Shinoda Y, Kawano H, Tanaka S, Choong PF. Systemic RANK-Fc protein therapy is efficacious against primary osteosarcoma growth in a murine model via activity against osteoclasts. J Pharm Pharmacol 2010; 62 (4) 470-476
    CrossrefPubMedGoogle Scholar
  • 21 Akiyama T, Choong PF, Dass CR. RANK-Fc inhibits malignancy via inhibiting ERK activation and evoking caspase-3-mediated anoikis in human osteosarcoma cells. Clin Exp Metastasis 2010; 27 (4) 207-215
    CrossrefPubMedGoogle Scholar