Second-look arthroscopic findings of 208 patients after ACL reconstruction

Abstract

The aim of this study is to report the arthroscopic subjective findings of reconstructed anterior cruciate ligament (ACL) with good clinical outcome. Graft used for reconstruction was either patella bone-tendon-bone (PBTB) autograft or hamstring tendon [quadrupled semitendinous and gracilis tendon (QSGT)] autograft. From March 1997 to September 2003, among 716 ACL reconstructions 209 knees (208 patients) were available for second-look arthroscopy at a mean 21.2-month (range, 14-70 months) postoperative period. The second-look arthroscopy focused on the evaluation of (1) continuity of the reconstructed ACL graft, (2) subjective graft tension using a probe, (3) the extent of synovial coverage, (4) the prevalence of cyclops or cyclops-like lesion, and (5) bony change after notchplasty. Patellar tendon autograft was used in 80 knees, hamstring tendon autograft in 129 knees. Just prior to second-look arthroscopy two objective clinical evaluations, KT-2000 arthrometer and Lysholm knee score, were performed to verify good clinical outcomes. A comparison between the hamstring tendon group and the patella tendon group, hamstring group showed slightly better results in Lysholm knee scores and KT-2000 arthrometer but there were no statistically significant differences (p>0.05). Undetected partial graft tear was seen in 21 knees (10%). With regard to graft tension, a total of 181 grafts (87%) showed normal tension and 28 (13%) showed slight lax tension. The overall synovial coverage was poor in nine (4%) knees. The synovial coverage was slightly better in the hamstring tendon group. A total of 45 knees (21.5%) showed cyclops-like lesion in variable sizes and locations. Reformation of the notch was seen in 85 knees (40%). In conclusion, the findings of second-look arthroscopy of reconstructed ACL in good clinical outcome patients showed approximately 10% partial graft tear, 5% poor synovial coverage, 20% cyclops-like lesion, and 40% some notch reformation.

Effects of Remnant Tissue Preservation on Clinical and Arthroscopic Results After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

“…12 The incidence of cyclops syndrome, which shows serious loss of knee extension caused by a hard nodule around the reconstructed ACL, has been reported to range from 2% to 11%. 3,40,43 In the present study, however, we did not encounter cyclops syndrome in either double-bundle procedure. In contrast, the incidence of a cyclops lesion, which is a soft synovial tissue mass without any clinical symptoms around the reconstructed ACL, has been reported to range from 2% to 47%.…”

Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment

“…This may require a secondary surgical procedure with ACL-plasty. On the other hand, persistent instability, meniscopathy or rerupture of the transplant has been described in up to 10% of cases even after primary ligament reconstruction [1]. In our patient sample a slightly increased reconstruction rate after conservative treatment is apparent and might be considered an argument in favor of primary ACL-reconstruction.…”

Comparing Dimensions of Four-Strand Hamstring Tendon Grafts with Native Anterior and Posterior Cruciate Ligaments

“…While extremely intense debate on surgical reconstruction techniques continues, the use of sufficiently robust grafts is recommended for both ligaments. Second-look arthroscopic examinations have shown that generally deterioration of the graft has occurred in the midsection [8, 9, 33]. One condition which could cause this is the compatibility of the graft used for reconstruction in place of both ACL and PCL.…”