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Age / Sex : 37 / M
Age/Sex: 37/M
C.C.: knee pain
1) What is your impression?
Courtesy : Jeong Mi Park, M.D, MD., St. Mary`s Hospital, College of Medicine, The Catholic University of Korea
Diagnosis: ACL ganglion with mucoid degeneration
Discussion
Findings:
MRI shows an increased signal of the ACL both in the T1- and T2-weighted images, with a mass-like configuration that was confused as a partial or complete tear of the ACL. There are some erosion of cortical bone beside the origin and insertion of ACL. Differential Diagnosis: ACL tear
Diagnosis: Mucoid degeneration and ganglion of ACL
Discussion:
Intraarticular ganglion cysts have been reported to occur in MRI in 1.3% of patients, with approximately 20% of these related to the anterior cruciate ligaments. Pathogenesis of this ganglia has been attributed to mucinous degeneration of connective tissue. On MR, mucoid degeneration begins with homogenous increased signal intensity within an ill-defined enlarged ACL. The individual fibers are intact, but spread apart, similar in appearance to that of a "celery stalk". Eventually, aloculated or multiloculated cyst can develop. This cyst, similar to a meniscal cyst, can be intraligamentous, periligamentous or both. Cystic enlargement of the ACL has been likened to the appearance of a "drumstick". As the cyst enlarges, scalloping of the intercondylar notch can occur from benign pressure erosions. Associated subchondral cysts (pseudocysts) are common. On post-contrast images, enhancement of the pericruciate synovium can be identified.
References:
1. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anterior Cruciate Ligament Ganglia and Mucoid Degeneration: Coexistence and Clinical Correlation Am J Roentgenol 2004; 182:1283-1287.
2. Narvekar A, Gajjar S. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2004; 20:141-146.
3.Andrikoula SI, Vasiliadis HS, Tokis AV et al. intraarticular agnlio of the knee joint associated with the anterior cruicate ligament: a report of 4 cases in 3 patients. Arthroscopy 2007; 23:800–806.
4. McIntyre J, Moellekens S, Tirman P. Mucoid degenerationf o the anterior cruciate ligament mistaken for ligamenous tears. Skeletal Radiol. 2001;30:312-315.
5. Melloni P, Valls R, Yuguero M, Saez A. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle. Skeletal Radiol.2004;33:359-362.
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