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Partial debridement is the most commonly reported treatment option for mucoid degeneration of the anterior cruciate ligament: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine clinical outcomes and risks of various management strategies for mucoid degeneration of the anterior cruciate ligament (MD-ACL).

Methods

Three databases MEDLINE, PubMed and EMBASE were searched from inception to January 29th, 2023 for literature outlining clinical outcomes for various management strategies of MD-ACL. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on satisfaction scores, visual analogue scale (VAS) scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, Knee Osteoarthritis and Outcome Scores (KOOS), range of motion and Lachman test were recorded.

Results

A total of 14 studies comprising 776 patients (782 knees) were included in this review. Partial debridement was reported in ten (71.4%) studies comprising 446 patients, showing significant improvements in VAS, Lysholm, IKDC scores and range of motion. Complete debridement was reported by two (14.2%) studies comprising 250 patients, and resulted in increases in Lysholm scores, KOOS, and range of motion. Reduction plasty was reported in two (14.2%) studies comprising 26 patients and showed improvements in VAS and Lysholm scores, and range of motion. Other methods of treatment included conservative management and ultrasound decompression. Complete debridement resulted in 10/23 (43%) patients with a positive Lachman test. This was followed by reduction plasty and partial debridement, with 5/26 (19.2%) and 45/340 (13.2%) patients respectively having positive Lachman or elevated knee arthrometer scores. Pivot shifting was only reported in studies on partial debridement and reduction plasty, with 14/93 (15.1%) and 1/21 (4.8%) patients have positive results, respectively.

Conclusion

The most commonly reported management strategy for MD-ACL is partial debridement with complete debridement, reduction plasty and conservative management as alternative options. Current operative management strategies place individuals at risk for ACL insufficiency. Information from this review can aid surgeons and clinicians in understanding what treatment options are best for this patient population, by understanding the reported clinical benefits and risks of each strategy.

Level of evidence

IV.

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Data availability

Data can be made available upon request when necessary at prushoth.vivekanantha@medportal.ca.

Abbreviations

MD-ACL:

Mucoid degeneration of the anterior cruciate ligament

ACL:

Anterior cruciate ligament

MRI:

Magnetic resonance imaging

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

R-AMSTAR:

Revised assessment of multiple systematic reviews

MINORS:

Methodological index for non-randomized Studies

PROM:

Patient reported outcome measure

VAS:

Visual analogue scale

IKDC:

International Knee Documentation Committee

KOOS:

Knee Osteoarthritis and Outcome Score

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Funding

The authors declare that no funds, grants, or other supports were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Prushoth Vivekanantha & Yi David Diao

  2. Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA

    Jeffrey Kay

  3. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Yuichi Hoshino & Kanto Nagai

  4. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main Street West, Hamilton, ON, 4E14, Canada

    Darren de SA

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  1. Prushoth Vivekanantha
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Correspondence to Darren de SA.

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Vivekanantha, P., Diao, Y.D., Kay, J. et al. Partial debridement is the most commonly reported treatment option for mucoid degeneration of the anterior cruciate ligament: a systematic review. Knee Surg Sports Traumatol Arthrosc 31, 4265–4275 (2023). https://doi.org/10.1007/s00167-023-07479-9

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