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.
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Epidemiology
The likelihood of mucoid change within ligaments and tendons increases with age 1.
Risk factors
Predisposing factors include the following 1:
- aging
- mechanical repetitive stress
- traumatic injury
Associations
Mucoid change is associated with the following conditions 2:
Clinical presentation
The clinical presentation mucoid change and includes pain, restricted range of motion and stiffness dependant on the localization 2,3.
Complications
Complications of mucoid change include the following 1-3:
Pathology
Histologically mucoid change is characterized by the degradation and disorganization of collagen fibers and the deposition of a mucoid substance containing new glycosaminoglycans within those fibers 1-7.
Location
Tendons and ligaments and fibrocartilage can be affected by the mucoid change, in particular, the following 6-10:
- Achilles tendon
- quadriceps tendon
- the long head of the biceps tendon
- rotator cuff
- anterior and posterior cruciate ligaments
- triangular fibrocartilage complex
- menisci
Radiographic features
Mucoid change can be seen on ultrasound or MRI.
Ultrasound
Hypoechoic foci are seen within or replacing the fibrillar architecture of tendons or ligaments, which might be surrounded by hyperemia on color or power Doppler 1.
MRI
Ligaments and tendons affected by mucoid change might display a thickened and/or ill-defined appearance characterized by nonspecific linear or globular increase in signal intensity.
Signal characteristics
Mucoid change shows increased signal intensity on all pulse sequences typically easily definable on T2 weighted and fat-saturated images, but poorly distinguishable on non-fat saturated proton density-weighted images 6,7.
- T1/PD: intermediate to mildly hyperintense
- T2/T2FS/PDFS: hyperintense
Radiology report
The radiological report should include a description of the following:
- location of the mucoid change within tendons and/or ligaments
- any associated partial or complete tears
- signs of impingement
- associated findings as degenerative joint disease
Treatment and prognosis
Treatment is only required if there are otherwise unexplained symptoms. It is then conservative and includes exercise therapy, activity modification, physical and manual therapy as well as nonsteroidal anti-inflammatory drugs ref.
Surgical treatment options depend on the specific location and include debridement and or partial excision in patients with refractory severe symptoms and impingement unresponsive to conservative treatment options 3.
Differential diagnosis
Conditions that can mimic the presentation and/or the appearance of mucoid change include 1,2:
- chondral metaplasia
- fatty infiltration
- ligamental sprain
- partial or interstitial tendon tear
- ganglion cysts
- synovial chondromatosis
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