Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients From the SANTI Study Group Database

Abstract

Background: Cyclops syndrome is characterized by a symptomatic extension deficit attributed to impingement of a cyclops lesion within the intercondylar notch. The syndrome is an important cause of reoperation after anterior cruciate ligament reconstruction (ACLR). It has been suggested that remnant-preserving ACLR techniques may predispose to cyclops syndrome, but there is very limited evidence to support this. In general terms, risk factors for cyclops syndrome are not well-understood. Purpose: To determine the frequency of and risk factors for reoperation for cyclops syndrome in a large series of patients after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who underwent primary ACLR between January 2011 to December 2017. Patients undergoing major concomitant procedures were excluded. Demographic data, intraoperative findings (including the size of preserved remnants), and postoperative outcomes were recorded. Those patients who underwent reoperation for cyclops syndrome were identified, and potential risk factors were evaluated in multivariate analysis. Results: A total of 3633 patients were included in the study, among whom 65 (1.8%) underwent reoperation for cyclops syndrome. Multivariate analysis demonstrated that preservation of large remnants did not predispose to cyclops lesions (odds ratio [OR], 1.11; 95% CI, 0.63-1.93). The most important risk factor was extension deficit in the early postoperative period. If present at 3 weeks postoperatively, it was associated with a >2-fold increased risk of cyclops syndrome (OR, 2.302; 95% CI, 1.268-4.239; P < .01), which was increased to 8-fold if present 6 weeks after ACLR (OR, 7.959; 95% CI, 4.442-14.405; P < .0001). None of the other potential risk factors evaluated were found to be significantly associated with an increased frequency of cyclops syndrome. Conclusion: Failure to regain full extension in the early postoperative period was the only significant risk factor for cyclops syndrome after ACLR in a large cohort of patients. Other previously hypothesized risk factors, such as preservation of a large anterior cruciate ligament remnant, did not predispose to the development of this debilitating postoperative complication.

Preservation of the Tibial Stump During Anterior Cruciate Ligament Reconstruction Surgery Did Not Increase the Rate of Surgery for Symptomatic Cyclops Lesions

“…Based on these findings, one might deduce that stump preservation has a protective effect on the development of cyclops lesions. However, a recent study by Delaloye et al, 5 which reported on 3633 patients, found no relationship between reoperation for cyclops lesions and the amount of stump preservation. The authors determined that the most important risk factor for reoperation for a symptomatic cyclops lesion was an extension deficit in the early postoperative period.…”

Lesões no joelho de atletas: período de destreinamento

“…Pode haver também, uma diminuição da amplitude de movimento, que pode ser resultado do impacto do enxerto e da artrofibrose localizada ou difusa. Essas lesões atléticas são muito comuns, sendo uma das condições mais comumente tratadas do joelho, e podem levar à síndrome do ciclope mesmo após anos da reconstrução (GIACOMO et al 2016;MORRISON, WILLIAM y MAJOR, 2015;BALCAREK et al, 2008;NOAILLES et al, 2019;DELALOYE et al, 2020). Essas consequências podem causar também um tipo de osteoartrite articular (OA), que ocorre quando o tecido flexível nas extremidades dos ossos do joelho se desgasta, isso é particularmente importante, pois lesões anteriores no joelho são um precursor bem reconhecido da OA e existe uma forte possibilidade de que uma incidência crescente de lesões esportivas, que possa resultar em uma carga futura cada vez maior de OA, após a aposentadoria desses atletas (FINCH, KEMP y CLAPPERTON, 2015;BENNELL, HUNTER y VICENZINO, 2012;LOHMANDER et al 2007).…”

Patellar Tendon Quality and Knee Symptoms in Male Athletes Before the Anterior Cruciate Ligament Reconstruction

“…It may be postulated that an ACL injury followed by an ACL reconstruction may aggravate this problem. AKP is also commonly present after ACL reconstruction [8], which might be in uenced by the graft choice, and might lead to persistent knee extensor muscles weakness [8][9][10][11]. It has been proposed that less AKP before the ACL reconstruction is predictive of better clinical outcomes at 12 months post-operative [12,13].…”