The cyclops lesion after bicruciate-retaining total knee replacement

Abstract

The cyclops lesion is a localized anterior arthrofibrosis most commonly seen following anterior cruciate ligament reconstruction. The lesion forms at the anterior cruciate ligament insertion creating a painful extension block between femoral intercondylar notch and tibial plateau. We present 2 cases (3 knees) in which cyclops lesions appeared atypically following bicruciate-retaining total knee replacement. Two lesions occurred in a single patient following bilateral knee replacement. One lesion occurred in an active sportswoman. All 3 resolved following arthroscopic debridement. We describe the presentation of this unusual complication and suggest keys to its diagnosis, treatment, and prevention.

Cyclops Lesions of the Knee: A Narrative Review of the Literature

“…A greater incidence of cyclops lesion in female patients, as high as 4 times greater than that in their male counterparts, has been reported by various studies. 24 , 27 A greater incidence has also been reported after bicruciate-retaining total knee arthroplasty 18 , 42 even without injury to the ACL. The cause has been proposed to be injury to the ACL during implantation of the prostheses and sharp edges of the tibial bone island.…”

“…Recommended strategies to prevent cyclops lesions include the following 2 , 6 : Delaying ACLR until after recovery of ROM Minimally invasive surgery compared with open ACLR Creating less debris by use of a sequential reamer and thorough removal of debris Correct tunnel positioning Debridement in and around the bone tunnel 23 Trial extension with the reamer or drill placed through the tibial tunnel to check whether it impinges with the notch Notchplasty if associated with impingement of the ACL graft If possible, drawing the graft from the femoral tunnel first into the tibial tunnel to draw debris into the tibial tunnel Early postoperative mobilization For cyclops lesion associated with bicruciate-retaining arthroplasty, selective fiber releases of the ACL, rounding of the edges of the tibial bone island, and notchplasty 18 …”

“…For cyclops lesion associated with bicruciate-retaining arthroplasty, selective fiber releases of the ACL, rounding of the edges of the tibial bone island, and notchplasty 18 …”

Arthroscopic treatment of total knee arthroplasty complications

“…Klaassena and Aikins presented the first report of cyclopean lesions in three TKAs with preservation of the cruciate ligaments. 20 The classic cyclopean lesion occurs after reconstruction of the anterior cruciate ligament (ACL). A fibrous nodule is fixed just anterolateral to the tibial insertion of the ACL graft.…”

Bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing TKA: what are the advantages and disadvantages?

“…Ligamentous tension balancing and precise reconstruction of the joint line hold more importance in BCR compared from cruciate sacrificing arthroplasty. Additional problems such as cyclops syndromespecifically to the new implantation techniquehave also emerged which were not encountered in routine arthroplasty techniques [5,6].…”