Abstract
Background
Cyclops lesions are a known complication following anterior cruciate ligament reconstruction
(ACLR) with a described incidence between 1.9% to 10.9%. The objective of this study
was to identify the incidence, timing, and variables that correlated with development
of a cyclops lesion, and if objective functional testing differed between patients
with and without cyclops lesions.
Methods
313 consecutive patients who underwent ACLR and participated in Lower-Extremity Assessment
Protocol (LEAP) testing at a single, academic institution were analyzed. Retrospective
chart review was performed to identify patient demographic factors, medical comorbidities,
and potential peri-operative risk factors. Postoperative functional outcome metrics
and patient reported outcomes were collected per the institution’s LEAP testing protocol.
Binary logistic regression was utilized to identify risk factors for cyclops lesions.
Objective functional outcomes and patient reported outcomes were compared between
patients with and without cyclops lesions.
Results
23/313 (7.35%) patients developed a cyclops lesion following ACLR, of which 17 (73.91%)
were found to be symptomatic. Concomitant meniscal repair correlated with an increased
likelihood of developing a cyclops lesion (p = 0.040); no other risk factors significantly
differed between cohorts. There were no clinically relevant extension deficits or
differences in objective functional performance measures at six months post-operatively
between study cohorts.
Conclusions
Concomitant meniscal repair may be associated with the development of cyclops lesions
due to restrictive postoperative range of motion protocols; however no other pre-
or intra-operative factors demonstrated significant correlation. Presence of a cyclops
lesion should be considered with late loss of knee extension after ACLR.
Keywords
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References
- Case Series: Cyclops lesion - extension loss after ACL reconstruction.Indian J Radiol Imaging. 2010; 20: 208-210https://doi.org/10.4103/0971-3026.69361
- Cyclops lesions of the knee: A narrative review of the literature.Orthop J Sports Med. 2020; 8 (2325967120945671)https://doi.org/10.1177/2325967120945671
- Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: A systematic literature review.Orthop Traumatol Surg Res. 2019; 105: 1401-1405https://doi.org/10.1016/j.otsr.2019.07.007
- Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction.Arthrosc: J Arthroscopic Related Surg. 2010; 26: 1483-1488
- Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction.Arthroscopy. 1990; 6: 171-178https://doi.org/10.1016/0749-8063(90)90072-l
- Intraarticular fibrous nodule as a cause of loss of extension following anterior cruciate ligament reconstruction.Arthroscopy. 1992; 8: 10-18https://doi.org/10.1016/0749-8063(92)90129-y
- MR imaging of cyclops lesions.AJR Am J Roentgenol. 2000; 174: 719-726https://doi.org/10.2214/ajr.174.3.1740719
- Additional surgery after anterior cruciate ligament reconstruction: can we improve technical aspects of the initial procedure?.Arthroscopy. 2008; 24: 88-95https://doi.org/10.1016/j.arthro.2007.08.012
- Progressive loss of knee extension after injury. Cyclops syndrome due to a lesion of the anterior cruciate ligament.Am J Sports Med. 2001; 29: 545-549https://doi.org/10.1177/03635465010290050401
- Serial MRI and clinical assessment of cyclops lesions.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 1090-1096https://doi.org/10.1007/s00167-013-2480-5
- Measures of Knee Function.Arthritis Care Res. 2011; https://doi.org/10.1002/acr.20632
- Incidence rate of anterior cruciate ligament reconstructions.Perm J. 2008; 12: 17-21
- Intercondylar notch size influences cyclops formation after anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 1092-1099
- Procedural intervention for Arthrofibrosis after ACL reconstruction: trends over two decades.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 532-537https://doi.org/10.1007/s00167-015-3799-x
- Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years.Eur Radiol. 2017; 27: 3499-3508https://doi.org/10.1007/s00330-016-4661-3
- Hamstring contracture after ACL reconstruction is associated with an increased risk of Cyclops syndrome.Orthop J Sports Med. 2017; 5 (2325967116684121)https://doi.org/10.1177/2325967116684121
- Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis.Knee Surg Sports Traumatol Arthrosc. 2020; 28: 2036-2043https://doi.org/10.1007/s00167-019-05722-w
- Second-look arthroscopic findings of 208 patients after ACL reconstruction.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 242-248https://doi.org/10.1007/s00167-006-0177-8
- Analysis of different kinds of cyclops lesions with or without extension loss.Arthroscopy. 2009; 25: 626-631https://doi.org/10.1016/j.arthro.2008.12.006
- Arthrofibrosis after anterior cruciate ligament reconstruction in children and adolescents.J Pediatric Orthopaed. 2011; 31: 811-817
- Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction.Joints. 2016; 3: 151-157https://doi.org/10.11138/jts/2015.3.3.151
- Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1729-1734https://doi.org/10.1007/s00167-011-1501-5
- The cost-effectiveness of meniscal repair versus partial meniscectomy in the setting of anterior cruciate ligament reconstruction.Arthroscopy. 2018; 34: 2614-2620https://doi.org/10.1016/j.arthro.2018.06.046
Article info
Publication history
Published online: November 17, 2022
Accepted:
November 3,
2022
Received in revised form:
September 21,
2022
Received:
July 19,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
