Management of mucoid degeneration of the anterior cruciate ligament: a systematic review
Aim: The aim of this study was to investigate the outcome of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported. Materials and Methods: This systematic review was performed according to the PRISMA guidelines. A systematic search in MEDLINE, Embase, Google Scholar, Chochrane, ISI web of science and Scopus was performed. Three independent literature searches were performed, one was done by an experienced librarian and 2 were done by 2 of the authors. The protocol was registered in the PROSPERO database. Results: A total of 8 studies met the inclusion criteria and were included in the systematic review. All 8 studies assessed the outcome of arthroscopic debridement of MDACL. A total of 288 knees in 267 patients were included. The mean age of patients ranged from 36-61 years, while the mean follow-up ranged from 13-72 months. We found a high association between MDACL, chondral lesions and meniscal tears, which ranged from 39-96% and 13-44% respectively. The rate of simultaneous meniscectomies ranged from 13-44%. Postoperative pain relief ranged from 53.8 % to 95 %. There was an improvement of postoperative outcome scores and range of movement, which was variable in each study. Lachman test was positive postoperatively in 10- 62 % of patients. Postoperative symptomatic instability ranged from 0-48.2%. Conclusion: Arthroscopic debridement of ACL resulted in good pain relief and improvement of knee outcome scores and the incidence of post-operative instability was variable between studies. However, the evidence is weak. MDACL is a common MRI finding in asymptomatic patients and commonly associated with other degenerative lesions, which makes it difficult to attribute the symptoms solely to MDACL. Postoperative improvement might be related to meniscectomies commonly done simultaneously with arthroscopic debridement or to the placebo effect of surgery. This needs to be taken in account when treating MDACL in the older age group of patient with other associated degenerative changes.
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