mucoid degeneration of acl physiotherapy

The clinical presentation is one of posterior pain with limited flexion. Anterior cruciate ligament (ACL) mucoid degeneration, along with tears and anterior cruciate ligament ganglion cysts, is a relatively common cause of increased signal within the anterior cruciate ligament (ACL). Knee Surg Sports Traumatol Arthrosc 19(8):13261333. MRI is better at detecting mucoid degeneration than arthroscopy, as the surface of the ligament is often intact. Nowadays, orthobiologics such as platelet-rich plasma (PRP) are increasingly used in ligament surgeries to improve healing. -Provided skilled hands on in post-op rehabilitation to various population including Head and neck cancers, Lymph edema management, Bone cancers. 2013;15(1). . 2022 Mar;14(1):76-89. doi: 10.4055/cios20163. A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. (100%). However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary. 287 (3): 912-921. -, Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. 42 Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle P. Melloni, R. Valls, M. Yuguero, A. Saez Medicine Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1016/j.arthro.2008.02.004, Morice A, Coupry A, Lintz F, Robert H (2013) Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Possible etiologies include: It is postulated that mucoid degeneration may be a predisposing factor in the formation of ACL ganglion cysts. Average improvement in flexion was 21.5 degrees (0 to 60 degrees). Disclaimer. However, in most studies a proportion of patients simultaneously underwent other arthroscopic procedures for associated pathological knee conditions (44% meniscectomies in the study of Cha et al.). Signal intensity of the anteromedial bundle (AMB) or posterolateral bundle (PLB) graft standardized to the intensity of the PCL was defined as signal intensity ratio (SIR). Google Scholar, Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D (2011) Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Score: 4.7/5 (45 votes) . A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Ever since mucoid degeneration of the anterior cruciate ligament (MD-ACL) was named by Kumar et al. Knee Surg Sports Traumatol Arthrosc. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Knee Surg Relat Res. PubMed As there was no control group in any of the studies and the natural history of MDACL is not known, the postoperative improvement may have been attributed to the placebo effect, simultaneous arthroscopic procedures or the postoperative rehabilitation, or may be due to the pain having resolved without treatment at all. Bergin et al. 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Bilateral Symptomatic Mucoid Degeneration of the Anterior Cruciate Ligament with Anterior Knee Pain but No Limited Knee Flexion. This is a rare pathological condition, in which, there is increased signal from within the ligament. J Chin Med Assoc. Patients in all studies presented with central or posterior knee pain, mainly with terminal extension in three studies [14, 16, 17]. 2020 Jun 2. el Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: a case report. Mucoid change or mucoid degeneration refers to the irreversible tissue degeneration due to the accumulation of mucin within the fibers of tendons, ligaments, and fibrocartilage. Federal government websites often end in .gov or .mil. AJR Am J Roentgenol. Reeducation. [17] do not mention whether any patients underwent biopsy (Table 3). To our knowledge, this is the first systematic review to look into the results of the management of MDACL. It is commonly identified on MRI in association with other pathological findings and can be confused with partial ACL tears. sharing sensitive information, make sure youre on a federal Clin Orthop Surg 10(3):307314. Bergin et al. Arthroscopy 24(6):642649. statement and Conclusion: the degree of laxity, and the patient's age and willingness to pursue vigorous postoperative physical therapy are other major determinants. That is usually the journal article where the information was first stated. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 2004;182 (5): 1283-7. official website and that any information you provide is encrypted GG and AM interpreted the results and reviewed the manuscript. What you feel (symptoms) You feel heaviness in knee joint. Level of evidence: Indian J Orthop 48(2):197202. to 44% in the study of Cha et al. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. eCollection 2013. 1. 2009 Jul;17(7):737-40. doi: 10.1007/s00167-008-0690-z. Therefore, indications for ACL resection must be carefully selected. MDACL is not uncommon, however, it is rarely symptomatic [4, 5]. (10%) and highest in the study of Ventura et al. Its function is to stabilize the knee while bending and rotating; the ACL also keeps the knee from shifting out of place or moving anteriorly (toward the front) with pivoting activities. Case report: Hotchen AJ, Demetriou C, Edwards D, Melton JTK. On physical exam, the Lachman test for ACL instability is negative with an ACL ganglion. It contrasts with cystic lesions better known as synovial cysts or intercondylar fossa cysts. Mucoid degeneration of A C L is more common and literature has also reported many cases, but for PCL only few cases have been reported in English literature. Postoperative pain relief was reported in seven studies. volume33, Articlenumber:26 (2021) In this review, the mean age of patients ranged from 31 to 78years; mean age was highest in the study of Kim et al. government site. Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. There was strong association with chondral lesions and meniscal tears. Introduction Mucoid degeneration of the anterior cruciate ligament (MDACL) is a rare entity, first described by Kumar et al. The ACL appears on MRI to be enlarged with cystic changes throughout, however it is intact. FOIA 2018. http://journals.sagepub.com/doi/10.1177/2325967118786930, Pandey V, Suman C, Sharma S, Rao SP, Kiran Acharya K, Sambaji C (2014) Mucoid degeneration of the anterior cruciate ligament: management and outcome. Bookshelf J Bone Joint Surg Ser B 81(2):304305. Unable to load your collection due to an error, Unable to load your delegates due to an error. It can cause pain and to a meniscal tear. The https:// ensures that you are connecting to the Background: 2010 Jun;96(4):400-6. doi: 10.1016/j.otsr.2010.02.008. : A Meta-Analysis. Introduction: 8600 Rockville Pike Mucoid degeneration is characterized by an increase in the mucoid ground substance in the connective tissue containing glycoprotein and mucoprotein [ 4 ]. Google Scholar, Salvati F, Rossi F, Limbucci N, Pistoia ML, Barile A, Masciocchi C (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. This site needs JavaScript to work properly. An official website of the United States government. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). reported total resection of the ACL in 68% of patients: one young patient had disabling instability and subsequent ACL reconstruction. [6], in 62% of patients (18 of 29) in the study of Lintz et al. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-3615, Case 11: with Hoffa fat pad ganglion cyst, Case 12: tibial nerve schwannoma and ACL mucoid degeneration, Case 1: Complete ACL tear and meniscal tears, Case 2: Anomalous insertion of the medial meniscus, View Frank Gaillard's current disclosures, see full revision history and disclosures, anterior cruciate ligament ganglion cysts, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Mucoid degeneration of the anterior cruciate ligament, congenital or acquired synovial tissue entrapment between ACL fibers. PubMed Central Characteristic: "celery stalk" appearance. https://doi.org/10.4103/0019-5413.101037, Srivastava A, Pateliya S, Singh H, Aggarwal S, Srivastava S (2016) Mucoid degeneration of anterior cruciate ligament management and functional outcome of 18 cases. 2008;24(6):642649. 2018;4(4):875-80. Mucoid degeneration of the ACL is suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences in MRI is identified in a patient with physically intact ligament and no obvious trauma history. -Evaluated and planned treatment protocol in accordance with physician. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. Seventeen females (67%) and eight males (33%) were included in the final analysis. 1 Its prevalence in magnetic resonance imaging (MRI) is 1.8-5.3%, but not all lesions are symptomatic.2, 3 It is characterized by infiltration of mucoid-like substance (glycosaminoglycans) interspersed within the Noninfiltrating synovial cysts of the ACL were excluded. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. In contrast to the tear, mucoid degeneration of the ACL characteristically does not cause knee instability [20, 21, 22]. The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. Roberts CC, Towers JD, Spangehl MJ et-al. Eight studies showed postoperative improvement in range of motion, whereas Khanna et al. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. Clin Orthop Surg. For treatment of this, partial removing of bulky ACL is generally done, which causes weakness of the ACL. Clin Orthop Surg. (A) Bulging of, Fig. The https:// ensures that you are connecting to the . Every time when patient flexes the knee, thickened ACL impinges over posterior cruciate ligament (PCL) in the knee, causing knee pain and limited motion. All rights reserved. Knee Surg Sports Traumatol Arthrosc. Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a well-recognized pathology characterized by the degradation of collagen fibers and infiltration of a mucoidlike substance, [1,2 . Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. . Arthroscopic diagnostic criteria [7] are (1) continuous ACL fibres, (2) increased ACL volume, (3) yellowish-coloured material expressed on palpation and (4) loss of ACL synovial lining. Symptomatic ACL mucoid degeneration in middle-age athletes. The pathogenesis remains controversial. See this image and copyright information in PMC. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. Arthroscopy. Knee Surg Sports Traumatol Arthrosc. Pain was posterior in 23 knees (80%). [16]. There was a high rate of association between degenerative lesions and MDACL, ranging from 39 to 96%. Any discrepancy was resolved by the senior author. The patient presented with extension block of the knee. Clinical outcome was reported using a variety of scores (the Lysholm and International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the visual analogue scale (VAS) score) in the different studies; these are summarized in Table 4. Indian J Orthop. Disclaimer. Magn Reson Imaging Clin N Am. Dietary management and various treatments Scanning and diagnostic . reported the largest percentage of patients (27.5%) with a positive pivot test. The main MRI finding of ACL mucoid degeneration is a celery stalk appearance [26, 27]. Before J Knee Surg. The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [ 5 ]. The origin of MDACL may be degenerative or traumatic. ACL ganglion cyst at arthroscopy may appear as a cystic mass with . Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. 6. MeSH (48.2% (14/29 patients) with symptomatic instability), which may be due to the large number of patients with total resection of the ACL (58.6% (17 out of 29 patients)) (Table 4). At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). I have persistent pain in the back of that knee that is exacerbated by walking and bending it. Epub 2011 Feb 18. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. FOIA Orthop Traumatol Surg Res 96(4):400406, Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR (2004) Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Ligaments and tendons are accumulated by mucoid change might display a thickened and/or hypertrophied appearance, with an increase in signal intensity. A 48-year-old-male patient presented with knee pain and limitation of motion. The reported restriction of range of movement was flexion deficit in four studies [3, 13, 15, 17], extension deficit in one study [14] and combined flexion and extension deficit in four studies [6, 16, 18, 19] (Table4). 2006;69(9):44952. 2018 Jun;25(3):445-452. doi: 10.1016/j.knee.2018.02.012. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. J Clin Epidemiol 62(10):10061012. PROSPERO. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. All studies focused on the outcome of arthroscopic debridement of MDACL, with no studies on conservative treatment. Coronal proton density-weighted magnetic resonance, Coronal proton density-weighted magnetic resonance imaging shows a thickening of the anterior cruciate, Sagittal proton density-weighted magnetic resonance, Sagittal proton density-weighted magnetic resonance image shows ill-defined anterior cruciate ligament with increased, Coronal T2 weighted fat suppressed fast spin echo image showed complex anterior cruciate, Pre-debridement arthroscopic view showing yellowish. Mucoid degeneration (MD) is a rare pathological affection of the anterior cruciate ligament (ACL). 2021 Aug 21;33(1):26. doi: 10.1186/s43019-021-00110-6. Skeletal Radiol. Rehabilitation, orthophony, crenotherapy. and transmitted securely. Bethesda, MD 20894, Web Policies The aetiology of MDACL is not fully understood, hence, there are multiple theories on this. The primary intervention was arthroscopic ACL debridement in eight studies; this was combined with notchplasty in cases of impingement with the lateral wall of the notch in five studies [6, 14, 16,17,18] (Table 3). Fig. reported on the co-existence of mucoid degeneration and ganglia of the ACL. Later studies reported that changes consist of mucoid Results degeneration, neovascularisation, and tendon sheath hyper- Nineteen patients met the inclusion criteria and were inclu- trophy. Symptomatic instability was highest in the study of Lintz et al. Cite this article. Accessibility With cruciate ligament ganglia, intact ACL fibers can often be visualized coursing through or around the cyst. PMC Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known pathology. It often presents with progressive knee pain, restriction in range of motion without a significant history of trauma, and without knee instability. These appearances must be differentiated from mucoid degeneration of the intact ACL. Arthroscopy. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.817.97 years (42-74 years). Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. sharing sensitive information, make sure youre on a federal as very low (04 points), low (58 points), good (912 points) or excellent (1316 points) [12]. They reported that a biopsy indicated mucoid degeneration and a relief of symptoms could be obtained through arthroscopic partial resection of the ligament. Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. -. maude adverse event report: genzyme biosurgery (ridgefield) synvisc one intra-articular hyaluronic acid Unauthorized use of these marks is strictly prohibited. J Chin Med Assoc. Careers. Int J Curr Res Aca Rev 4(11):1824 http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI (2008) Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. 8600 Rockville Pike PMC AJR Am J Roentgenol. Anatomopathology samples were collected in 18 cases. Hamdaoui and others published Le signe de la branche de cleri | Find, read and cite all the research you need on ResearchGate However, in the case of mucoid degeneration secondary signs of an ACL injury are usually absent. The purpose of this study was to investigate the outcome of management of MDACL by performing a systematic review of methods of treatment that have been reported. mucoid degeneration of acl mri. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Items are scored as 0 (not reported), 1 (reported but inadequate) or 2 (reported and adequate). Arthroscopic debridement of the mucoid degeneration of the ACL was safe and effective in the patient. Arch Orthop Trauma Surg. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Mar;50(3):3000605221084865. doi: 10.1177/03000605221084865. ANZ J Surg 73(9):712716. The https:// ensures that you are connecting to the Epub 2018 Jun 13. Only nine studies met our inclusion criteria and they were all case series. Read More Created for people with ongoing healthcare needs but benefits everyone. 2001;17(9):E37. All nine studies were case series; six were retrospective and three were prospective studies. Due to the lack of specific symptoms and signs, its diagnosis is often delayed or even misdiagnosed in clinical practice [ [1] , [2] ]. Several critical distinctions allow a confident diagnosis of an ACL ganglion cyst. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos device. Exclusion criteria were (1) case reports, literature reviews and conference abstracts and (2) studies written in languages other than English. Mucoid degeneration of the anterior cruciate ligament (ACL) is a very rare cause of knee pain. In six of the nine studies [6, 14, 16,17,18], arthroscopic debridement of the ACL was associated with simultaneous partial meniscectomy; this ranged from 13% in the study of Morice et al. The quality of methodology was excellent in one study, good in five studies, low in two studies and very low in one study (Tables 1 and 2). Before Does Femoral Intercondylar Notch Volume Differ in Anterior Cruciate Ligament-Injured Adult Patients Compared to the Uninjured? Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. No treatment is usually required. 2011 Aug 1;19(8):1326-33. We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). ACL mucoid degeneration is an uncommon pathological condition; the pathogenesis, prevalence, and . Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. Unauthorized use of these marks is strictly prohibited. An anterior cruciate ligament (ACL) mucoid degeneration, along with tears and anterior cruciate ligament ganglion cysts, is a relatively common cause of increased signal within the. Would you like email updates of new search results? This site needs JavaScript to work properly. have described the following MRI criteria [4]: (1) high signal intensity in the T1 and T2 sequences, (2) increased ACL volume and (3) continuous fibres of ACL shown in the T2 sequence. Anterior Cruciate Ligament (ACL) Mucoid Degeneration Anatomy Anterior Cruciate Ligament, is an important structure of the knee joint. Mumbai, Maharashtra, India. Pan African Medical Journal. The origin of MDACL may be degenerative or traumatic. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Initially, partial weightbearing is allowed. Recent studies have reported that the prevalence of ACL mucoid degeneration is approximately 2-14% [20, 23, 24, 25]. 2022 Apr 11;31:67-71. doi: 10.1016/j.jor.2022.04.004. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CW. Arthroscopic debridement of the ACL was the intervention in eight studies, whereas Morice et al. 1. Ventura D, Nuez JH, Joshi-Jubert N, Castellet E, Minguell J. Clin Orthop Surg. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. Physical Therapy. -osis is a suffix denoting a process, condition, or state, the histology of the Achilles tendon and in ACL injuries(24-26). Anatomically, it is arranged in a crossed pattern with the Posterior Cruciate Ligament, forming an 'X', therefore, it is also known as cruciform ligament. Only three studies mentioned failed conservative treatment as an inclusion criterion [14, 15, 18]. Radiologic findings associated with mucoid degeneration of the anterior cruciate ligament. Patients with symptomatic MDACL commonly present with posterior knee pain and limitation of knee flexion or extension [2, 6]. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review, https://doi.org/10.1186/s43019-021-00110-6, https://doi.org/10.1302/0301-620X.81B2.0810304, https://doi.org/10.1007/s00167-011-1433-0, https://doi.org/10.2214/ajr.182.5.1821283, https://doi.org/10.1007/s00167-012-1991-9, https://doi.org/10.1016/j.arthro.2003.11.030, https://doi.org/10.1016/j.jclinepi.2009.06.005, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087782, https://doi.org/10.1046/j.1445-2197.2003.02748.x, http://journals.sagepub.com/doi/10.1177/2325967118786930, http://www.ijcrar.com/abstractview.php?ID=228&vol=4-11-2016&SNo=3, https://doi.org/10.1016/j.arthro.2008.02.004, https://doi.org/10.1016/j.jajs.2015.12.001, https://doi.org/10.4055/cios.2018.10.3.307, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Conclusions: It is a chronic degenerative change of a bulky ACL that may lead to notch impingement syndrome in the absence of instability symptoms and significant trauma history [ 1, 2, 3, 4 ]. Accessed 1 Mar 2021. Mucoid degeneration itself is described as a yellow or brown substance which can be either seen through the most anterior fibers of the ACL or found by probing between them [ 19, 35] (Fig. Correlations between degree of knee instability and SIR were assessed for each bundle, each time point, and each sequence. Intact fibers are best seen on T2WI. 2004;182(5):12837. Eight studies reported postoperative instability. The site is secure. Unable to load your collection due to an error, Unable to load your delegates due to an error. Conditions that resembles the clinical findings are: Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. 2022 Oct 23;34(1):40. doi: 10.1186/s43019-022-00169-9. Epub 2013 Aug 27. The mean follow up ranged from 13 to 72months. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. 2004 Feb;20(2):141-6. doi: 10.1016/j.arthro.2003.11.030. Careers. Chudasama CH, Chudasama VC, Prabhakar MM. J Bone Joint Surg Br. Online ahead of print. and transmitted securely. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. https://doi.org/10.1007/s00167-011-1433-0, Article FOIA Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Epub 2010 May 8. Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. Knee Surg Sports Traumatol Arthrosc 21(3):658663. in this condition your acl (anterior cruciate ligament) filled with jelly like material and it thickened so space in intercondylar resion of knee joint is reduced. Arthroscopically ACL is intact but fibrillated, yellowish and hypertrophied,with interspersed yellowish mucinous material along the fibers, lack of synovial linning of the ACL.

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