Early reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the anterior cruciate ligament

Abstract

Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. Although arthroscopic resection of the degenerated ACL is the treatment of choice following the failure of conservative management, the extent of the excision and subsequent ACL reconstruction for postoperative knee instability remains controversial.

Case reports: We present four cases of mucoid degeneration of the ACL in patients aged <40 years, and suggest a suitable treatment strategy for younger patients. All four patients (mean age, 33.8 years) were diagnosed with mucoid degeneration of the ACL based on characteristic clinical symptoms and magnetic resonance imaging. Arthroscopic resection of the affected portion of the ACL was performed as follows: partial resection in two cases with limited hypertrophy, and total ACL resection in the remaining two cases with degeneration involving the entire ligament. Preoperative symptoms disappeared in all cases after resection of the lesions. In the two patients with partial resection, the ACL was completely torn during subsequent sports activities despite showing no symptoms of instability for 2 years postoperatively. All four patients, including the two treated by total resection, underwent ACL reconstruction using an autogenous hamstring tendon.

Conclusion: Considering the rupture of residual ACL fibres after partial resection and the inevitability of total ACL resection due to degeneration of the entire ligament, ACL reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the ACL.

Keywords: anterior cruciate ligament; mucoid degeneration; reconstruction; young patient.

Fig. 1

Magnetic resonance imaging findings show an enlarged ligament with intermediate signal intensity on T1-weighted images.

Fig. 2

Magnetic resonance imaging findings show high signal intensity on T2-weighted images, despite maintenance of continuity.

Fig. 3

Arthroscopic findings show that the hypertrophied anterior cruciate ligament, with loss of synovial coverage, filled the intercondylar area.

Fig. 4

Histological examination of the excised fragments reveal the presence of multifocal myxoid changes (large black arrow) within anterior cruciate ligament collagen fibres (black arrow) and oedematous fibrous tissue.