Cyclops Syndrome Research Articles

A tight anterosuperior intercondylar notch may increase the risk of cyclops syndrome after anterior cruciate ligament reconstruction using a quadruple semi-tendinosus short autograft

BackgroundCyclops syndrome is loss of terminal knee extension caused by a fibrous nodule developed in the anterior intercondylar notch. The many known risk factors include preoperative motion-range limitation, tibial tunnel malposition, and tight hamstrings. The primary objective of this study was to assess whether intercondylar notch size was associated with the risk of cyclops syndrome or graft tear after anterior cruciate ligament (ACL) reconstruction using a quadruple semi-tendinosis autograft. The secondary objective was to determine whether intercondylar notch size was associated with functional outcomes. HypothesisA narrow intercondylar notch is associated with higher risks of cyclops syndrome and poor functional outcomes. MethodsConsecutive patients who underwent ACL reconstruction by quadruple semi-tendinosus autograft were included retrospectively. Preoperative magnetic resonance imaging scans were assessed by a single senior surgeon, who determined the conventional notch width index (NWI) and the anterior NWI (aNWI) for each patient. ResultsThe 120 included patients had a mean follow-up of 2.4±0.8 years. Among them, 20 (16.7%) experienced cyclops syndrome and 7 (5.8%) graft rupture. At last follow-up, 26 (21.7%) had not returned to sports and only 47 (39.2%) had returned to sports at the pre-injury level. The mean Lysholm score was 87.9±13.5 and the main subjective IKDC score was 84±13. A narrow notch was significantly associated with lower likelihoods of returning to sports (p=0.001), returning to the same sport (p<0.0001), and returning to the pre-injury sport level (p=0.004). By multivariate analysis, only the aNWI index was significantly associated with the risk of cyclops syndrome (p<0.0001). An aNWI index lower than 0.18 had 85% sensitivity and 78% specificity for predicting cyclops syndrome. ConclusionA narrow anterosuperior intercondylar notch may increase the risk of cyclops syndrome after ACL reconstruction using a quadruple semi-tendinosus graft but is not associated with the risk of graft rupture. Level of evidenceIV, retrospective observational cohort study.

Cyclops syndrome following anterior cruciate ligament reconstruction: Can relapse occur after surgery?

Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10% after anterior cruciate ligament reconstruction. However, recurrent cyclops lesions have rarely been documented. There are case rare series in the literature regarding the treatment of recurrent cyclops lesion. Future large studies are needed to investigate factors contributing to the development of cyclops lesions and syndrome and treatment options.

LONG-TERM CLINICAL OUTCOMES AFTER SINGLE- VERSUS DOUBLE-BUNDLE ACL RECONSTRUCTION: A MATCHED-PAIR ANALYSIS FROM THE SANTI STUDY GROUP

IntroductionIt has been contentious whether an anatomic double-bundle technique for anterior cruciate ligament reconstruction (ACLR)is superior to that of a single-bundle technique. It has been hypothesized in the literature that the double-bundle technique could provide function closer to that of the anatomical knee joint. The purpose of this study was to compare the long-term clinical outcomes after single-bundle ACLR versus double-bundle ACLR. We hypothesized that the double-bundle technique would not be superior to the single-bundle technique.MethodsA retrospective, non-randomized, matched-paired comparative study was performed. Patients undergoing primary anterior cruciate ligament reconstruction, using either a double-bundle or single-bundle technique, between 2003 and 2008 were included and matched 1:1. Matching included age, sex, BMI, time from injury to surgery, side of injury and type of sport. Patients who underwent revision procedures, multiligament reconstruction or other ACLR techniques were excluded. Patients were subsequently followed up, noting occurrence of graft rupture and any other complications.ResultsA total of 1377 ACLRs were performed during the study period. Seven hundred and fifty-six patients were excluded, leaving 396patients to be included in the matching (198 matched pairs). Mean follow-up time was 176.7 +/− 7.7 months (range, 166–211 months). Overall, 40 patients (10.1%) suffered from a graft rupture which consisted of 22 patients (11.1%) in the single-bundle group and 18patients (9.1%) in the double-bundle group. A multivariate analysis was performed using the Cox model and demonstrated that graft failure had no significant association with the surgical technique (hazard ratio (HR), 0.857(0.457;1.609), p=0.6313). (Figure 1) Five patients (2.5%) in the single-bundle group and 7 patients (3.5%) in the double-bundle group underwent secondary surgery for cyclops syndrome(p=0.5637). Three patients (1.5%) in the single-bundle group and 2 patients (1.0%) in the double-bundle group underwent arthrolysis(p=0.6547). Seven patients (3.5%) in the single-bundle group underwent secondary meniscectomy compared to 6 patients (3.0%) in the double-bundle group (p=0.7630).ConclusionDouble-bundle ACLR is not superior to single-bundle ACLR at long-term follow up. Therefore, orthopaedic surgeons do not need to use a double-bundle technique when performing ACL reconstruction.For any figures or tables, please contact authors directly.

Recurrent cyclops lesion after primary anterior cruciate ligament reconstruction using bone tendon bone allograft: A case report

BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament (ACL) reconstruction, with symptomatic cyclops syndrome occurring in up to 11% of surgeries. Recurrent cyclops lesions have been rarely documented; this case study documents the successful treatment of a recurrent cyclops lesion. CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee. Workup and clinical exam revealed an ACL tear, and arthroscopic reconstruction was performed. Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy. Seven months postoperatively, the patient presented with pain, stiffness, and difficulty achieving terminal extension. A smaller recurrent cyclops lesion was diagnosed, and a repeat synovectomy was performed. The patient recovered fully. CONCLUSION To the best of our knowledge, this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.

Paper 26: Clinical Outcomes of Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone-Patellar Tendon-Bone Autograft As The Gold Standard: A Matched-Pair Analysis of 2018 Patients

Objectives: The aims of this study were to compare the clinical outcomes following “gold standard” ACL reconstruction (ACLR) with a Bone-Patellar Tendon-Bone (BPTB) autograft versus ACLR combined with an anterolateral ligament reconstruction (ALLR) using hamstring tendon autografts (HT), in a large series of propensity matched patients. The hypothesis was that combined ACLR+ALLR would confer better graft rupture rates and lower non-graft rupture related re-operation rates than isolated ACLR with BPTB Methods: A retrospective analysis of prospectively collected data was performed. Patients undergoing ACLR+ALLR using HT between January 2003 and December 2019 were propensity matched in a 1:1 ratio to patients undergoing isolated ACLR using BPTB. At the end of the study period rates of graft rupture and any other re-operations or complications that occurred following the index procedure were identified by database interrogation, review of medical records and standardized telephone interview. Kaplan Meier survivorship analyses and Cox-proportional hazards models were used to evaluate graft survivorship, re-operation free survivorship and the significance of potentially important risk factors. Results: A total of 2018 patients (1009 matched pairs) were included. The mean duration of follow-up was 101.3 months. Kaplan Meier Analysis demonstrated a significantly better graft survivorship in the ACLR+ALLR group when compared to the BPTB group at every time point (Fig 1 and Table 1). The Cox model demonstrated that patients in the BPTB group were &gt; 3-fold more likely to experience graft failure (Hazard Ratio (HR) = 3.554 [1.744;7.243], p = 0.0005). Patients aged less than 20 years were at particularly high risk of graft rupture (HR = 5.65 [1.834;17.241], p = 0.0002) and further analysis of this subgroup demonstrated that isolated ACLR with BPTB also conferred a &gt; 3 fold increased risk of graft rupture in young patients when compared to ACLR+ALLR. Multivariate analysis did not identify any other significant risk factors for graft rupture. Overall, there was a significantly higher reoperation rate following isolated ACLR (BPTB group 20.5%, ACLR+ALLR group 8.9%, p &lt; 0.0001). This finding was accounted for by significantly higher rates of graft rupture (9.9% vs 3.5%, p &lt;0.0001), cyclops syndrome (3.3% vs 1.5%, p &lt;0.0001), and secondary meniscectomy (5% vs 2.9%, p=0.0196) in the BPTB group. Conclusions: Patients who underwent isolated ACLR with BPTB autografts experienced significantly worse ACL graft survivorship and overall re-operation free survivorship when compared to those who underwent combined ACLR+ALLR with hamstring autografts. The risk of graft rupture was more than 3-fold higher in patients who underwent isolated ACLR using BPTB. [Table: see text]

Histological and clinical analysis of knee cyclops lesions.

Cyclops Syndrome, first described by Jackson and Schaefer in 1990, is known as a complication of anterior cruciate ligament reconstruction (ACLR). However further researches have demonstrated that cyclops can be present even without symptoms and/or in absence of ACLR, simply configuring itself as a lesion in patients with rupture of the native ligament. This is a retrospective cohort study in which we report our experience of 13 cyclops lesions found between 126 patients during a primary arthroscopic ACLR. Preoperative examination with tests of joint stability and range of movement measurement was performed and recorded. Accurate joint examination was performed during arthroscopy and the cyclops lesions found were removed and analyzed with haematoxylin-eosin coloration. Post-operative clinical examination was performed until 6 months of follow-up. Histological analysis showed proliferation of dense fibroelastic polypoid nodules with a macroscopically histological aspects of a "blue eye", hence the name Cyclops. At 6 months of follow-up after surgery, none of the patients reported pain at terminal extension or instability and they were all able to resume their previous activities. Our study confirmed that surgical reconstruction of the ACL is not the only condition in which the Cyclops Syndrome develops; in fact our histological analysis indicate that the Cyclops lesions develop like a reactive fibroproliferative process following the rupture of the native ACL fibers, as scar reaction to the trauma: for this reason an accurate arthroscopic detection of these Cyclops lesions is crucial during primary ACL reconstruction in order to obtain the best surgical outcomes.

The Covid 19-Related Lockdown Increased The Rate of Cyclops Syndrome After ACL Reconstruction for Patients With Unexpected Home-based Self-Guided Rehabilitation

The Covid 19-Related Lockdown Increased The Rate of Cyclops Syndrome After ACL Reconstruction for Patients With Unexpected Home-based Self-Guided Rehabilitation

Association of COVID-19 Lockdown With Increased Rate of Cyclops Syndrome in Patients With Unexpected Home-Based Self-Guided Rehabilitation After ACL Reconstruction.

The risk of cyclops syndrome increases significantly after anterior cruciate ligament (ACL) reconstruction (ACLR) if complete extension is not recovered before the sixth postoperative week. The lockdown in France due to the COVID-19 pandemic led to an absence of supervised rehabilitation, requiring unexpected self-rehabilitation in patients who underwent ACLR just before lockdown. To determine the rate of cyclops syndrome after ACLR in patients who underwent self-rehabilitation during lockdown. Cohort study; Level of evidence, 3. A total of 75 patients receiving a hamstring graft for ACLR during the COVID-19 pandemic between February 10, 2022, and March 16, 2020, carried out self-rehabilitation during part of their first 6 postoperative weeks using exercise videos on a dedicated website. Clinical examination was performed at a minimum 1-year follow-up with International Knee Documentation Committee (IKDC), Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI) scores. This group was compared with a matched-pair control group of 72 patients who underwent surgery in 2019 and completed postoperative supervised rehabilitation with a physical therapist. Rates and reasons for second surgery (arthrolysis, meniscal procedure) were also recorded. In the COVID group (n = 72; 3 patients were lost to follow-up), the mean follow-up was 14.5 ± 2.1 months (range, 13-21) and rate of reoperation for clinical cyclops syndrome was 11.1% (n = 8). The rate of cyclops syndrome was significantly lower (1.4%) in the control group (P = .01). In the COVID group, 8 patients underwent anterior arthrolysis at a mean of 8.6 months after the primary surgery, and 4 patients underwent another surgical intervention (meniscal procedure [n = 3], device removal [n = 1]). In the COVID group, mean Lysholm was 86.6 ± 14.1 (range, 38-100), Tegner was 5.6 ± 2.3 (range, 1-10), subjective IKDC was 80.3 ± 14.7 (range, 32-100) and ACL-RSI score was 77.3 ± 19.7 (range, 33-100). The rate of cyclops syndrome after ACLR was significantly greater in the COVID group versus the matched controls. The dedicated website was not effective at supporting self-guided rehabilitation and could benefit from interactive improvements so it is at least as effective as supervised rehabilitation.

Postoperative regular use of a self-rehabilitation mobile application for more than two weeks reduces extension deficit and cyclop syndrome after anterior cruciate ligament reconstruction

PurposeTo investigate the minimum use that correlates with the best outcomes in term of complications associated with self-directed rehabilitation mobile application and to explore the user profile and usage habits.MethodsThis was a single-center retrospective study of 356 patients who underwent ACL reconstruction surgery between November 2019 and August 2020. Complications were defined as the presence of an extension deficit ≥ 5° after 6 weeks and/or the presence of cyclops syndrome. The demographics, sports competition level and number of connections were collected by the application.ResultsThe complication rate was reduced 4.2-fold with at least 2 weeks of use (2.4% (3/123) (with 0.8% (1/123) of cyclops syndrome) versus 10.8% (23/212) (with 3.3% (7/212) cyclops syndrome), p = .04). The mean duration of use was 20 ± 23 days with a frequency of 2.1 ± 2.3 connections per day. The usage rate was 50% in week 1, 35% in week 2, and 24% in week 3. There was one peak in the abandon rate during the first few days of use and a second peak at Day 10 when physiotherapy sessions started. There were two dips in the abandon rate associated with the follow-up visits at Days 21 and 45. Greater use was found in older patients (p = .0001) and female patients (p = .04).ConclusionsWhen using the application for a minimum of 2 weeks, the risk of complications was reduced 4.2-fold. The typical users of a self-directed rehabilitation application after ACL surgery in this study were women and patients over 30 years of age.Level of evidenceIV, retrospective.

Bone-patellar tendon-bone autograft and female sex are associated with the presence of cyclops lesions and syndrome after anterior cruciate ligament reconstruction.

Associated risk factors for the development of cyclops lesions have been little. Investigated, because most previous studies have limited their research to cases with symptomatic cyclops lesions (cyclops syndrome). The purpose of this study was to evaluate the presence of cyclops lesions using magnetic resonance image (MRI) at 6 and 12months after anterior cruciate ligament reconstruction (ACL-R), and to investigate the associated risk factors of cyclops lesions and syndrome. A retrospective analysis of patients who underwent ACL-R using bone-patellar tendon-bone (BTPB) or hamstring tendon autograft from 2008 to 2017 was conducted. Predictor variables (age, sex, body mass index [BMI], time from injury to ACL-R, preinjury Tegner activity score, graft, meniscal and cartilage injury, and notch width index on MRI for the presence of cyclops lesions and syndrome were analyzed with multivariate logistic regression. Four hundred and fifty-five patients (225 males and 230 females) were enrolled. One hundred and four patients (22.9%) had cyclops lesions, and all cyclops lesions were detected on MRI at 6months post-operatively. In addition, 20 patients (4.4%) had cyclops syndrome which means that these were symptomatic cases. The risk factors for presence of cyclops lesions were BPTB autograft (OR = 2.85; 95% CI 1.75-4.63; P < 0.001) and female sex (OR = 2.03; 95% CI 1.27-3.25; P = 0.003). The presence of cyclops syndrome increased with graft (BPTB) (OR = 18.0; 95% CI 3.67-88.3; Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation P < 0.001), female sex (OR = 3.27; 95% CI 1.07-10.0; P = 0.038), and increased BMI (OR = 1.21; 95% CI 1.05-1.39; P = 0.008). All cyclops lesions were detected 6months after ACL-R, and the majority of them were asymptomatic. BPTB autograft and female sex were the significant risk factors for the presence of cyclops lesions and syndrome. In addition, increased BMI was associated with a higher risk of developing cyclops syndrome. When BPTB autograft is used for a female patient, full active knee extension should be encouraged in the early period after ACL-R to prevent cyclops lesion formation. Level IV, retrospective case series.

Low reoperation rate following lateral meniscus root repair: clinical outcomes at 2years follow-up.

The aim of this study was to review the outcomes of lateral meniscus posterior root tears repair at the time of ACL reconstruction at a minimum 2-year follow-up. Between March 2015 and August 2018, 2017 patients underwent primary ACL reconstruction and were considered for study eligibility. Lateral meniscus posterior root tears were identified arthroscopically, and repair was performed with a transtibial pull-out suture technique or a side-to-side suture technique. Clinical outcomes were recorded at the time of physical examination. At the end of the study period, patients were contacted to determine whether they had required reoperation. Lateral meniscus posterior root tears were identified in 153 out of the 2,017 primary ACL reconstructions (7.6%). Ninety-nine patients were included for analysis: 23 transtibial pull-out sutures and 76 side-to-side repairs. At a mean follow-up of 42 ± 10months, one patient (1%) had undergone reoperation for failure of the side-to-side repair. There were 11 reoperations in 10 patients (10.1%), including 6 cyclops syndrome, 1 graft rupture, 1 tibial bone cyst, 1 medial and 1 lateral meniscus repair failure, and 1 arthrolysis. Postoperatively, ninety (90.9%) patients were graded A for the IKDC objective score and 9 (9.1%) patients were graded B, with an IKDC subjective score of 86.9 ± 7.6, a Lysholm score of 90.7 ± 6.7 and a median Tegner Activity Scale of 6 (3-9). All of their objective and subjective evaluations improved after surgery (p < 0.001) except for the Tegner Activity Scale. Ten patients underwent second look arthroscopy (10.1%), lateral meniscus healing was observed in 9 out of 10 patients (90%). This study demonstrated that lateral meniscus posterior root tear repair is a safe procedure with a very low reoperation rate at a minimum follow-up of 2years. IV.

Evaluation of a smartphone application for self-rehabilitation after anterior cruciate ligament reconstruction during a COVID-19 lockdown

BackgroundRehabilitation after surgery is a crucial process that governs the final functional outcome. The self-rehabilitation smartphone application Doct’up (Healing SAS, Lyon, France) is designed for patients who have had anterior cruciate ligament (ACL) reconstruction surgery. In France in the spring of 2020, the lockdown mandated due to the COVID-19 pandemic prevented patients from seeing their physiotherapists for 2 months. The objective of this study was to compare the clinical outcomes in two groups of patients who underwent ACL reconstruction surgery: in one group, surgery performed before the lockdown was followed by standard in-person physiotherapy while, in the other, surgery was done just before the lockdown and rehabilitation was performed by the patients themselves using the phone application. HypothesisUsing a self-rehabilitation smartphone app limits the negative effects of not receiving physiotherapist rehabilitation after ACL reconstruction. Material and methodsWe performed a case-control study involving the retrospective analysis of prospectively collected data from two groups of patients who had undergone ACL reconstruction surgery. Patients in the App group had surgery just before the 2-month COVID-19-related lockdown that started in France on March 17, 2020,and used only the smartphone app for rehabilitation. The standard-care group was composed of matched controls who had surgery 1 year before the cases and received rehabilitation therapy during in-person physiotherapist visits. The ACL reconstruction technique was the same in the two groups. The primary outcome measure was extension lag 6 weeks after surgery. The secondary outcome measures were extension lag 3 weeks and 6 months after surgery, quadriceps muscle activation, knee extension locking 3 and 6 weeks after surgery, and the 6-month rate of surgical revision for cyclops syndrome. ResultsWe included 32 cases managed using only self-rehabilitation guided by the phone app, and we identified 101 matched controls managed using standard care. We found no significant between-group difference in extension lag after 6 weeks: 9.4% (28/32) vs. 4.6% (87/101), p=0.39. After 3 weeks, the App group had a higher proportions of patients with quadriceps activation (94% [30/32] vs. 73% [74/101], p=0.015) and extension control using canes (78.1% [25/32] vs. 40.6% [41/101], p=0.0002). None of the other measured outcomes differed significantly between the two groups (extension lag after 3 weeks: 12.5% [4/32] vs. 13.8% 14/101]; extension lag after 6 months: 3.2% [1/32] vs. 1% [1/101]; quadriceps activation after 6 weeks: 97% [31/32] vs. 99% [100/101]; extension locking with canes after 6 weeks: 96.9% [31/32] vs. 93.1% [94/101]; extension locking without canes after 3 weeks: 53.2% [17/32] vs. 47.5% [48/101]; extension locking without canes after 6 weeks: 93.7% [30/32] vs. 82.2% [83/101]; and surgery for cyclops syndrome (3.1% [1/32] vs. 1% [1/101]). DiscussionThe use of a self-rehabilitation phone app after ACL reconstruction during a COVID-19 lockdown limited the adverse effects of not receiving in-person physiotherapy. The 6-month outcomes were similar to those seen with standard rehabilitation. The study results demonstrate the usefulness of self-rehabilitation after ACL reconstruction surgery. Self-rehabilitation guided by a phone app could be used as a complement to the protocols generally applied by physiotherapists. Level of evidenceIV, single-centre retrospective case-control study.

Are running stitches needed in DT4 Single Anteromedial Bundle Biological Augmentation transplant preparation?

Partial running whipstitches are commonly used in DT4 SAMBBA (Single Anteromedial Bundle Biological Augmentation) transplant preparation. We wanted to determine whether or not running whipstitches all over the graft affected the risk of iterative rupture and the overall outcome of the procedure. Two groups of 32 patients comparable in terms of sex, age, sport level and type of sport practiced were recruited in this prospective cohort study. DT4 SAMBBA was performed for all patients by a single surgeon. One cohort was treated with a full length running whipstitches during SAMBBA DT4 transplant preparation (F), the other had a classical SAMBBA DT4 graft preparation (NO F). The ACL RSI, subjective IKDC and KOOS scores were established preoperatively and with a 4 years follow-up. Complication rates (iterative rupture, cyclops syndrome) as well as pre and postoperative score variations were calculated. No statistically significant difference in terms of frequency of iterative rupture or complications could be demonstrated (NO F 9.3% vs F 3.1%, p = 0.61). There was no difference either on score variations compared pre and post operatively. Full running whipstitches of the DT4 SAMBBA transplant does not seem to influence the ligamentoplasty outcomes with a 4 years follow-up.

Excision of a Knee Cyclops Lesion Using a Needle Arthroscope

After anterior cruciate ligament (ACL) reconstruction surgery, achieving full range of motion and strength of the postoperative knee is critical for optimal surgical outcomes. Abnormal tissue growth and scar formation in the postoperative knee can create a block to terminal extension of the knee. Cyclops lesions are areas of granulation tissue with neovascularization and fibrous tissue formation peripherally, most commonly at the anterolateral aspect of the tibial graft site after ACL reconstruction. When these lesions block terminal extension and cause mechanical symptoms, cyclops syndrome is diagnosed, and secondary knee arthroscopy is often performed to remove this tissue to allow for full range of motion. This Technical Note describes a minimally invasive approach with the NanoScope. The NanoScope allows for decreased postoperative pain and swelling with a likely quicker recovery back to normal postoperative therapy.

Femoral intercondylar notch: Accuracy of a novel MRI measurement protocol

ObjectiveThe most common mechanical complication following an anterior cruciate ligament (ACL) reconstruction is joint stiffness, due in part to cyclops syndrome. A narrow intercondylar notch is an anatomical risk factor. A reliable preoperative notch measurement would help anticipate proper graft size, or plan a notchplasty during the ligament reconstruction, if necessary. No study has yet assessed the accuracy of the methods used to measure notch size. HypothesisThe novel measurement protocol proposed in this study would be more reproducible than the reference technique. MethodsA total of 20 preoperative knee MRIs performed during the assessment of an ACL rupture were randomly selected. The notch size was measured using 2 methods: traditional (ratio of the notch and metaphyseal widths measured on a line drawn through the popliteal groove) and novel. The latter was measured using the same ratio but took into account the notch width in its proximal third, according to a coronal slice that passes through the ACL tibial attachment. Three orthopedic surgeons with different levels of experience (senior surgeon, junior surgeon and surgical resident) performed these measurement protocols twice on anonymized MRI scans, 10days apart. Spearman's rank correlation coefficient was used to assess the intraobserver correlations and a concordance index was used to assess the interobserver correlations. The influence of the second MRI reading was analyzed with a bootstrap test. ResultsThe mean intraobserver reliability was 0.73 for the reference method and 0.83 for the proposed method. The values of the bootstrap tests were higher for the proposed method (0.45 vs. 0.45 and 0.70; p<05 for interobserver; 0.49 vs. 0.69 and 0.62; p<05 for intraobserver). ConclusionThe proposed measurement protocol showed a higher reproducibility in assessing notch size than the traditional method. This technique therefore provides a reliable assessment of the intercondylar notch width. Level of evidenceIV; retrospective study.

Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition in ACL reconstruction.

PurposeThe purpose of this study was to determine whether direct arthroscopic control of femoral buttons can prevent improper deployment and soft tissue interposition in anterior cruciate ligament (ACL) reconstruction.MethodsA retrospective analysis of prospectively collected data from the SANTI study group database was performed. All patients who underwent ACL reconstruction using suspensive femoral fixation between 01/01/2017 and 31/12/2019 were included. Patient assessment included demographics, sports metrics, reoperations performed and femoral button-related specific complications such as iliotibial band (ITB) irritation and/or septic arthritis. Proper deployment of the button and soft tissue interposition were assessed on postoperative radiographs.ResultsA total of 307 patients underwent ACL reconstruction using adjustable femoral button fixation and were analyzed after a mean follow-up of 35.2 ± 11.0 months (14.3–50.2). The mean age was 39.5 ± 10.9-years old (range 13.3–70.6). Postoperative radiographs showed a correctly deployed femoral button without soft tissue interposition for all patients. No septic arthritis was reported. Nine patients (2.9%) suffered from lateral pain related to ITB irritation due to the button. Five of them had their symptoms resolve during rehabilitation. Ultrasound-guided corticosteroid infiltration was necessary for four patients after an average delay of 14.5 ± 4.8 months (11.7–21.7). Three patients were then symptom-free, but one required surgical removal of the implant 27.5 months after the surgery. Regarding unrelated femoral button complications, 15 patients (4.9%) underwent secondary arthroscopic procedures, including meniscectomy (1.6%), surgery for cyclops syndrome (2.6%) and revision ACLR (0.7%).ConclusionArthroscopic confirmation of femoral button deployment prevents soft tissue interposition without specific complications.Level of evidenceLevel IV.

Analysis of intercondylar notch size and shape in patients with cyclops syndrome after anterior cruciate ligament reconstruction

BackgroundCyclops lesion is the second most common cause of extension loss after anterior cruciate ligament reconstruction. This study focused on the correlation between the anatomy of the intercondylar notch and the incidence of cyclops lesion. To determine whether the size and shape of the intercondylar notch are related to cyclops lesion formation following anterior cruciate ligament reconstruction according to magnetic resonance imaging (MRI) findings.MethodsOne hundred twenty-five (125) patients were retrospectively evaluated. The notch width index (NWI) and notch shape index (NSI) were measured based on coronal and axial MRI sections in patients diagnosed with cyclops syndrome (n = 25), diagnosed with complete anterior cruciate ligament (ACL) tears (n = 50), and without cyclops lesions or ACL ruptures (n = 50).ResultsImaging analysis results showed that the cyclops and ACL groups had lower mean NWI and NSI values than the control group. Significant between-group differences were found in NSI (p = 0.0140) based on coronal cross-sections and in NWI (p = 0.0026) and NSI (p < 0.0001) based on axial sections.ConclusionsThe geometry of the intercondylar notch was found to be associated with the risk of cyclops lesion formation and ACL rupture.

Analysis of Risk Factors For Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction

Cyclops syndrome is an important cause of re-operation after anterior cruciate ligament (ACL) reconstruction. The objectives of this study were to evaluate the incidence and risk factors for the development of cyclops syndrome in a large series of patients undergoing ACL reconstruction. Retrospective analysis of prospectively collected data was performed including all patients who underwent primary ACL reconstruction between January 2011 to December 2017. All patients who underwent re-operation for arthroscopic debridement of a symptomatic cyclops lesion were identified and potential risk factors were analyzed in a multivariate logistic regression. 3633 patients were included in the study. 65 (1.8%) underwent re-operation for cyclops syndrome. Table 1 reports the differences between those who did, and did not develop cyclops syndrome, with respect to patient demographics, intra-operative variables, and the percentage of patients regaining full extension by 3 and 6 weeks post-operatively. Multivariate analysis demonstrated that the only significant risk factor for cyclops syndrome was early knee extension deficit after ACL reconstruction. Patients who had a knee extension deficit at 3 weeks postoperatively had a >2-fold increase in the risk of developing a cyclops syndrome (OR = 2.302, IC 95% 1.268 – 4.239; p < .01) and the risk was 8–fold greater when the extension deficit was still present 6 weeks after ACL reconstruction (OR = 7.959, IC 95% 4.442 – 14.405; p<.001). None of the other variables studied (those listed in Table 1), including preservation of large ACL remnants was proven to be an important risk factor. The preservation of large ACL remnants does not predispose to cyclops syndrome after ACLR. The most important risk factor for development of cyclops syndrome is extension deficit in the early post-operative period.

Evaluation of Combined Anatomic Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction in Anterolateral Rotatory Instability of the Knee

Some studies has demonstrated improved dynamic rotational stability with a double bundle reconstruction. However, another multiple studies did not find improved functional rotational stability, also cost and time needed and the increased incidence of cyclops syndrome are causes of technique limitation. We aimed to evaluate of results of combined anatomic ACL and anterolateral ligament reconstruction in patients with anterolateral rotatory instability of the knee. Twenty patients with chronic ACL insufficiency were subjected to combined anatomic single-bundle ACL reconstruction and anterolateral ligament reconstruction by semitendinosus and gracilis tendons. International Knee Documentation Committee (IKDC) subjective knee evaluation form (page 76, 77) was filled and scores were recorded. The results of this technique show excellent (normal) results in 18 patients grade A according to objective IKDC and very good (near normal) in 2 patients. Range of motion at 3 months follow up was limited to 90° to 110° in 7 patients, all these patients were improved with physiotherapy and rehabilitation programs with no need to other management.Isometric ALL is highly important to prevent tight lateral compartment of the knee and prevent limited range of motion and lateral side knee pain. There is no major complication associated with this technique to limit its use.

Hemorrhagic Cyclops Syndrome after Anterior Cruciate Ligament Reconstruction - A Rare Cause of Recurrent Hemarthrosis: About Two Cases and Review of the Literature.

Introduction:Cyclops syndrome is a classic complication after anterior cruciate ligament (ACL) reconstruction and usually manifests as an extension deficit. A presentation dominated by recurrent hemarthrosis has never been reported.Case Report:We report the cases of two patients who underwent ACL hamstring reconstruction and whose post-operative recurrent hemarthrosis revealed the presence of a cyclops syndrome typical lesion.Conclusion:Theses atypical presentations of cyclops syndrome should alert surgeons that post-operative hemarthrosis after ACL reconstruction may reveal fibrous nodule at the tibial insertion of the graft by a cyclops lesion and that a puncture should be performed to bring back hemorrhagic fluid. It is imperative that treatment should include coagulation of this hypervascularization to avoid any recurrence.