Occurrence rate of Cyclops lesion after anatomic double-bundle anterior cruciate ligament reconstruction with remnant tissue preservation: Comparisons with Conventional Procedure
ESSKA Academy. Masashi C. May 12, 2018; 218167; FP49-620
Dr. Chimbe Masashi
Dr. Chimbe Masashi
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Objectives: We have developed anatomic double-bundle (DB) ACL reconstruction with ligament remnant tissue preservation, and this procedure significantly improved postoperative knee stability. There has been apprehension that remnant preservation may increase the occurrence rate of cyclops syndrome or cyclops lesion after ACL reconstruction surgery. However, no previous studies have shown about cyclops lesion after (DB) ACL reconstruction with remnant tissue preservation. The purpose of this study was to compare occurrence rate of cyclops lesion after anatomic DB ACL reconstruction with or without remnant tissue preservation.

Methods: A total of 162 patients who underwent anatomic DB ACL reconstruction procedure using hamstring tendon autografts were enrolled in this study between 2007 and 2017. There were 92 men and 70 women with a mean age of 28.5 years (13-66 years) at the time of surgery. Based on the Crain classification of ACL remnant tissue, 82 patients of Crain Type I, II, and III underwent the remnant-preserving procedure (Group P) and the remaining 80 patients of Crain Type IV underwent the remnant-resecting procedure (Group R). Cyclops lesion was defined as a fibrous nodule (>5 mm) around the ACL graft. All the patients underwent 2nd look arthroscopy, and were evaluated the incidence of the cyclops lesion and clinical results. Statistical comparison was made using the Mann-Whitney U-test and the chi-square test. The significance level was set at p = 0.05.

Results: There were no significant difference in the background factors between the 2 groups. Side-to-side differences in the anterior laxity at 30° of knee flexion was significantly less (p=0.04) in Group P (0.8 mm) than in Group R (1.4 mm). There were no significant differences in the clinical evaluations (Lysholm score, IKDC evaluation) between the 2 procedures. Incidence of Cyclops lesion was significantly higher (p=0.0402) in Group R (33.8%) than Group P (19.5%). The location of the cyclops lesion was divided into the 3 portions; proximal (Type I), middle (Type II), and distal (Type III) of the ACL graft in the femoral notch. Type III was significantly higher (p=0.0013) in Group R (17.5%) than in Group P (0.024%). Each 2 patients had loss of knee extension more than 5° in Groups P and R. Sagittal T2-WI MRI could be found the nodule of cyclops lesion, and the average of cross-sectional area was 116 (SD 66) mm2 and 172.3 (50.9) mm2, in Groups P and R. Each sensitivity and specificity was 86% and 91%. Histologically, the nodule was the presence of disorganized dense fibroconnective tissue in 15 cases. In 2 of 15 cases, fibrocartilage tissue and bone debris were found.

Conclusions: The most important finding of the present study was that the occurrence rate of cyclops lesion of remnant resecting procedure was significantly higher in DB ACL reconstruction. We suggest that anatomic DB ACL reconstruction with remnant tissue preservation may reduce cyclops lesion.

DB ACL reconstruction,Cyclops,remnant
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