Aier Sashitemjen, Das Anurag, Nayak Shalini, Pandey Vivek
Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, IND.
Physiotherapy, Manipal College of Health Professionals, Manipal Academy of Higher Education, Udupi, IND.
Cureus. 2024 Feb 6;16(2):e53735. doi: 10.7759/cureus.53735. eCollection 2024 Feb.
Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is an unusual cause of knee pain and restricted movement, predominantly affecting the middle-aged population. Arthroscopic partial or total debridement of the mucoid ACL is the surgical treatment of choice. However, little is discussed in the literature regarding subsequent knee instability and functional outcomes following complete ACL excision.
A retrospective study was conducted on patients who underwent arthroscopic total ACL excision for mucoid ACL. Pre- and post-operatively, the Tegner-Lysholm score, the International Knee Documentation Committee (IKDC) Subjective Knee Form, and subjective functional instability were used to grade the clinical outcomes.
Ten out of the 13 patients who underwent complete ACL excision were available for evaluation. All patients presented with knee pain on deep flexion or extension with a painfully limited range of motion. Post-operatively, all patients were relieved of their original pain and dysfunction. The mean post-operative IKDC and Tegner-Lysholm scores were 74.96 and 83.6, respectively. All patients had a Lachman test positive, while only two had a grade 1 pivot shift test positive. Two patients had occasional functional instability only after strenuous exercises. None of the patients underwent subsequent ACL reconstruction.
All patients reported improved functional outcomes. Only two out of 10 reported occasional instability during strenuous activity. Therefore, complete debridement of mucoid ACL in sedentary patients is safe and efficacious. However, active young patients may experience instability and require ACL reconstruction if it hinders their daily activities.
前交叉韧带（ACL）的黏液样变性（MD）是导致膝关节疼痛和活动受限的罕见原因，主要影响中年人群。关节镜下对黏液样ACL进行部分或全部清创是首选的手术治疗方法。然而，关于完全切除ACL后膝关节随后出现的不稳定和功能结果，文献中讨论较少。
对因黏液样ACL而接受关节镜下完全ACL切除的患者进行了一项回顾性研究。术前和术后，使用Tegner-Lysholm评分、国际膝关节文献委员会（IKDC）主观膝关节表格以及主观功能不稳定情况对临床结果进行分级。
13例接受完全ACL切除的患者中有10例可供评估。所有患者在深度屈伸时均出现膝关节疼痛，活动范围严重受限。术后，所有患者的原有疼痛和功能障碍均得到缓解。术后IKDC和Tegner-Lysholm评分的平均值分别为74.96和83.6。所有患者的Lachman试验均为阳性，而只有2例患者的1级轴移试验为阳性。仅2例患者在剧烈运动后偶尔出现功能不稳定。所有患者均未进行后续的ACL重建。
所有患者均报告功能结果有所改善。10例患者中只有2例报告在剧烈活动期间偶尔出现不稳定。因此，对于久坐不动的患者，完全清创黏液样ACL是安全有效的。然而，活跃的年轻患者可能会出现不稳定，如果这妨碍了他们的日常活动，则需要进行ACL重建。
