What Effects Were Reported for Intraligamentous Steroid Injection in ACL Mucoid Degeneration Unresponsive to Conservative Treatment?

Pain improved in 78 of 82 knees (95.1%). Motion restriction resolved in 49 of the 50 knees that had restricted motion.

Participants and Methods

The study included 82 knees, with a mean age of 64 years and mean follow-up of 19.5 months. Cases from one institution were analyzed retrospectively. After identifying the ACL femoral attachment under fluoroscopy, a 22 G needle and triamcinolone 40 mg were used. PROM changes and symptom recurrence were evaluated using Kaplan–Meier analysis.

The order in which you read the painting.

This original figure shows fluoroscopic checks of a needle directed toward the ACL’s femoral attachment, in coronal and sagittal views. The target differs from a routine intra-articular injection. A retrospective single-arm study of 82 MDACL knees unresponsive to conservative care. Read the 95.1% initial improvement with the 48.8% 1-year recurrence rate to distinguish response from durability. Without controls, superiority over surgery or other injections is not established; follow-up MRI and quantitative ROM were limited.

Main Findings

Pain improved in 78 of 82 knees (95.1%). Motion restriction resolved in 49 of the 50 knees that had restricted motion. NRS decreased from 5.1 to 1.7 at 3 weeks. Kaplan–Meier symptom-recurrence rates were 19.5% at 3 months, 39.0% at 6 months and 48.8% at 1 year.

The point of reading on surgery

This study examines the feasibility of an intermediate treatment considered before arthroscopic intervention. It does not establish comparative efficacy or safety against other treatments.

Limitations

There was no control group, and ROM was documented qualitatively in clinical notes. There was no follow-up MRI. The paper gives conflicting rates of pain relief beyond 6 months, 70.5% and 61.0%, so this proportion cannot be presented as a definitive result.

Let's put it briefly.

What did this study confirm?

Pain improved in 78 of 82 knees (95.1%). Motion restriction resolved in 49 of the 50 knees that had restricted motion.

Can it be applied directly to individual patients' treatment decisions?

Keywords

Anterior cruciate ligament
Fluoroscopy
Glucocorticoids
Knee joint
Mucoid degeneration
Anterior Cruciate Ligament
Steroids
Retrospective Studies

Abstract · Original text

Sang Yoon Kim, Byung Sun Choi, Du Hyun Ro, Hyuk-Soo Han. Efficacy of Intraligamentous Steroid Injection in Pain Reduction and Knee Motion Improvement in Patients with Mucoid Degeneration of the Anterior Cruciate Ligament. Clinics in orthopedic surgery. 2026;18(4):658-665. doi:10.4055/cios25280.

BACKGROUND

This study assessed the efficacy and safety of fluoroscopy-guided intraligamentous steroid injections in managing mucoid degeneration of the anterior cruciate ligament (MDACL) in patients resistant to oral medication and intra-articular steroid injections.

METHODS

A retrospective review of 294 knees diagnosed with MDACL via magnetic resonance imaging between October 2014 and June 2023 was conducted. After applying exclusion criteria and excluding patients who were asymptomatic or showed improvement with conservative treatment, 82 knees were included in the final analysis. Intraligamentous steroid injections were performed under C-arm fluoroscopy by a single orthopedic surgeon. Clinical data collected included the duration of the pain-free period, patient-reported outcome measures (PROMs; pain numeric rating scale, the International Knee Documentation Committee subjective score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score), range of motion, and other radiological measures. Symptom recurrence rates were determined using the Kaplan-Meier survival analysis.

RESULTS

The average age at the time of injection was 64.0 years (range, 39-83 years), and the mean follow-up period was 19.5 months (range, 12-90 months). Pain improvement was noted in 78 of 82 knees (95.1%), with an average effect duration of 7.8 months (standard deviation, 9.1). Improvement of limitation of knee motion was observed in 49 of 50 cases (98.0%). Kaplan-Meier analysis indicated symptom recurrence rates of 19.5% at 3 months, 39.0% at 6 months, and 48.8% at 1 year. All PROMs significantly improved after injection for 6 months (p < 0.01) and then slightly declined. No patients reported post-procedure instability.

CONCLUSIONS

Fluoroscopy-guided intraligamentous steroid injection demonstrated short-term efficacy in relieving pain and improving knee motion in MDACL patients resistant to conventional treatments, although further studies are warranted to confirm these findings.

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The original paper.

Efficacy of Intraligamentous Steroid Injection in Pain Reduction and Knee Motion Improvement in Patients with Mucoid Degeneration of the Anterior Cruciate Ligament

Sang Yoon Kim, Byung Sun Choi, Du Hyun Ro, Hyuk-Soo Han
Clinics in Orthopedic Surgery · 2026

DOI · 10.4055/cios25280 PubMed Based data

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