Summary

Arthroscopic total excision of mucoid material and ACL reconstruction gives superior results to partial excision [debridement] of anterior cruciate ligament in treatment for mucoid degeneration of the anterior cruciate ligament

Abstract

Background

Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Surgical treatment for mucoid degeneration varies from partial excision to complete debridement with or without ACL Reconstruction. However, no consensus exists on the agreed treatment of mucoid degeneration. The aim of this study was to compare two modalities of treatment of mucoid degeneration of ACL: Partial debridement of mucoid Vs Complete debridement and ACL reconstruction.

Methods

A simple randomised clinical trial was done to compare the two modalities of treatment between 2015 and 2020. Minimum follow up was 2 years. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Inclusion criteria were clinical and radiological [Celery stock appearance on MRI] diagnosis of Mucoid degeneration of ACL. Exclusion criteria were significant osteoarthritis in knee [>Grade 2 Kellgren Lawrence], malalignment and prior surgery or other concomitant pathology in the same knee.

Results

Ninteen females (73%) and seven males (27%) were included in the final analysis. The mean age at the time of surgery was 57 years (range, 40 to 68 years). Partial resection of the anterior cruciate ligament was done in twelve cases and a complete resection followed by ACL reconstruction in fourteen cases. At last follow-up, the difference in mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improvement (p < 0.05) was significantly better in the reconstruction group compared to the partial excision group.

Discussion

Our results support earlier studies where complete debridement and ACL reconstruction have superior results compared to partial debridement. Results of partial debridement are inferior due to inadequate control of how much disease tissue needs to be removed. If disease tissue is left it may result in inadequate recovery after surgery and excessive removal may result in instability.

Conclusions

Our study provides further evidence that arthroscopic total excision of mucoid material and ACL reconstruction gives superior results to partial excision [debridement] of anterior cruciate ligament in treatment for mucoid degeneration of the anterior cruciate ligament.