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

Abstract

PurposeAssociated 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 12 months after anterior cruciate ligament reconstruction (ACL‐R), and to investigate the associated risk factors of cyclops lesions and syndrome. MethodsA 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. ResultsFour 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 6 months 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). ConclusionsAll cyclops lesions were detected 6 months 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 of evidenceLevel IV, retrospective case series.

Influence of female sex and double‐quadruple semitendinosus‐gracilis graft on the incidence of postoperative symptomatic cyclops lesions after ACL reconstruction

“…Tomihara et al reported an incidence of 4.4% for symptomatic cyclops lesions. Additionally, they found a higher risk for cyclops lesions in patients with a BPTB graft compared with a hamstring graft, female patients and patients with a higher BMI [34]. Recent studies concluded an incidence of 6.7%–7.2% in different graft types [12, 13].…”

Hamstring Anterior Cruciate Ligament Autograft Contributes to a Delayed Symptomatic Cyclops Lesion: A Case Report

“…In more recent years there have been questions as to whether particular graft selection leads to a higher incidence of cyclops lesions and syndrome following ACLR. Studies have demonstrated that bone patellar bone autograft compared to hamstring autograft as well as female sex and increased BMI leads to increased rates of cyclops syndrome [16]. Quadriceps tendon autograft is becoming a popular choice of graft selection among surgeons as it shows similar biomechanical outcomes as well as improved cosmesis in comparison to other graft selections.…”

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

“…It is known that the use of hamstring or patellar graft does not constitute a risk factor in the development of cyclops lesion. However, there are also studies reporting that bone-tendon-bone graft is a risk factor[ 2 , 5 ]. In fact, the list of risk factors is long and most of time it is difficult to say which factors caused it in a case report.…”