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Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years

  • Magnetic Resonance
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Abstract

Objectives

To assess the impact of cyclops lesions with MRI in patients treated for anterior cruciate ligament (ACL) tears on clinical outcome.

Methods

In 113 patients (age 29.8 ± 10.5y; 55 females; BMI 24.8 ± 3.7 kg/m2) with complete ACL tear, 3 T-MRI scans were obtained before, 6-months, 1-year (n = 75) and 2-years (n = 33) after ACL reconstruction. Presence and volume of cyclops lesions were assessed. Clinical outcomes were measured using the Knee injury and Osteoarthritis Outcome Score (KOOS) and differences between time points (∆KOOS) were calculated. Changes of KOOS subscales were compared between patients with and without cyclops lesion. KOOS was also correlated with lesion volume.

Results

Cyclops lesions were found in 25% (28/113), 27% (20/75) and 33% (11/33) of patients after 6-months, 1- and 2-years, respectively. The lesion volume did not change significantly (P > 0.05) between time points, measuring 0.65 ± 0.59, 0.81 ± 0.70 and 0.72.9 ± 0.96 cm3, respectively. Clinical outcomes based on KOOS subscales were not significantly different in patients with cyclops lesions compared to those without cyclops lesions (each comparison P > 0.05), and no significant associations of clinical outcomes with lesion volume were found (P > 0.05).

Conclusions

Neither presence nor size of cyclops lesions within the first 2-years after ACL surgery were associated with inferior clinical outcome.

Key Points

• Cyclops lesions had a prevalence of 25% in patients after ACL reconstruction.

• Subjects with cyclops lesions did not have an inferior clinical outcome.

• Cyclops lesions developed within the first 6 months after surgery.

• The size of cyclops lesions did not significantly change over a period of 2 years.

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References

  1. Marrale J, Morrissey MC, Haddad FS (2007) A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:690–704

    Article  PubMed  Google Scholar 

  2. Giaconi JC, Allen CR, Steinbach LS (2009) Anterior cruciate ligament graft reconstruction: clinical, technical, and imaging overview. Top Magn Reson Imaging 20:129–150

    Article  PubMed  Google Scholar 

  3. Fullerton LR Jr, Andrews JR (1984) Mechanical block to extension following augmentation of the anterior cruciate ligament. A case report. Am J Sports Med 12:166–168

    Article  PubMed  Google Scholar 

  4. Millett PJ, Wickiewicz TL, Warren RF (2001) Motion loss after ligament injuries to the knee. Part I: causes. Am J Sports Med 29:664–675

    CAS  PubMed  Google Scholar 

  5. Papakonstantinou O, Chung CB, Chanchairujira K, Resnick DL (2003) Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol 13:1106–1117

    PubMed  Google Scholar 

  6. Bencardino JT, Beltran J, Feldman MI, Rose DJ (2009) MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 29:2115–2126

    Article  PubMed  Google Scholar 

  7. Sonnery-Cottet B, Lavoie F, Ogassawara R et al (2010) Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26:1483–1488

    Article  PubMed  Google Scholar 

  8. Jackson DW, Schaefer RK (1990) Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 6:171–178

    Article  CAS  PubMed  Google Scholar 

  9. Watanabe BM, Howell SM (1995) Arthroscopic findings associated with roof impingement of an anterior cruciate ligament graft. Am J Sports Med 23:616–625

    Article  CAS  PubMed  Google Scholar 

  10. Wang J, Ao Y (2009) Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy 25:626–631

    Article  PubMed  Google Scholar 

  11. Mariani PP, Ferretti A, Conteduca F, Tudisco C (1992) Arthroscopic treatment of flexion deformity after ACL reconstruction. Arthroscopy 8:517–521

    Article  CAS  PubMed  Google Scholar 

  12. Recht MP, Piraino DW, Cohen MA, Parker RD, Bergfeld JA (1995) Localized anterior arthrofibrosis (cyclops lesion) after reconstruction of the anterior cruciate ligament: MR imaging findings. AJR Am J Roentgenol 165:383–385

    Article  CAS  PubMed  Google Scholar 

  13. Simpfendorfer C, Miniaci A, Subhas N, Winalski CS, Ilaslan H (2015) Pseudocyclops: two cases of ACL graft partial tears mimicking cyclops lesions on MRI. Skelet Radiol 44:1169–1173

    Article  Google Scholar 

  14. Delcogliano A, Franzese S, Branca A, Magi M, Fabbriciani C (1996) Light and scan electron microscopic analysis of cyclops syndrome: etiopathogenic hypothesis and technical solutions. Knee Surg Sports Traumatol Arthrosc 4:194–199

    Article  CAS  PubMed  Google Scholar 

  15. Muellner T, Kdolsky R, Grossschmidt K, Schabus R, Kwasny O, Plenk H Jr (1999) Cyclops and cyclopoid formation after anterior cruciate ligament reconstruction: clinical and histomorphological differences. Knee Surg Sports Traumatol Arthrosc 7:284–289

    Article  CAS  PubMed  Google Scholar 

  16. Marzo JM, Bowen MK, Warren RF, Wickiewicz TL, Altchek DW (1992) Intraarticular fibrous nodule as a cause of loss of extension following anterior cruciate ligament reconstruction. Arthroscopy 8:10–18

    Article  CAS  PubMed  Google Scholar 

  17. Hettrich CM, Dunn WR, Reinke EK, Group M, Spindler KP (2013) The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 41:1534–1540

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tonin M, Saciri V, Veselko M, Rotter A (2001) Progressive loss of knee extension after injury. Cyclops syndrome due to a lesion of the anterior cruciate ligament. Am J Sports Med 29:545–549

    CAS  PubMed  Google Scholar 

  19. Fisher SE, Shelbourne KD (1993) Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction. Am J Sports Med 21:558–564

    Article  CAS  PubMed  Google Scholar 

  20. Shelbourne KD, Johnson GE (1994) Outpatient surgical management of arthrofibrosis after anterior cruciate ligament surgery. Am J Sports Med 22:192–197

    Article  CAS  PubMed  Google Scholar 

  21. Eckenrode BJ, Sennett BJ (2011) Arthrofibrosis of the knee following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 41:32

    Article  PubMed  Google Scholar 

  22. Sanders TL, Kremers HM, Bryan AJ, Kremers WK, Stuart MJ, Krych AJ (2015) Procedural intervention for arthrofibrosis after ACL reconstruction: trends over two decades. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3799-x

    Google Scholar 

  23. Sheldon PJ, Forrester DM, Learch TJ (2005) Imaging of intraarticular masses. Radiographics 25:105–119

    Article  PubMed  Google Scholar 

  24. Bradley DM, Bergman AG, Dillingham MF (2000) MR imaging of cyclops lesions. AJR Am J Roentgenol 174:719–726

    Article  CAS  PubMed  Google Scholar 

  25. Cha J, Choi SH, Kwon JW, Lee SH, Ahn JH (2012) Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques. Skelet Radiol 41:997–1002

    Article  Google Scholar 

  26. Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF (2001) Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med 29:213–218

    CAS  PubMed  Google Scholar 

  27. Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64

    Article  PubMed  PubMed Central  Google Scholar 

  28. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 63:S208–S228

    Article  Google Scholar 

  29. Ahn JH, Yoo JC, Yang HS, Kim JH, Wang JH (2007) Second-look arthroscopic findings of 208 patients after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 15:242–248

    Article  PubMed  Google Scholar 

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Acknowledgements

The scientific guarantors of this publication are Prof. Xiaojuan Li and Dr. Luca Facchetti. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by NIH/NIAMS AR060752 and by the Arthritis Foundation. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained at all participating centers. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, observational, multicenter study.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA

    Luca Facchetti, Benedikt J. Schwaiger, Alexandra S. Gersing, Julio Brandao Guimaraes, Lorenzo Nardo, Sharmila Majumdar, Thomas M. Link & Xiaojuan Li

  2. Department of Radiology, University of Brescia, Brescia, Italy

    Luca Facchetti

  3. Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil

    Julio Brandao Guimaraes

  4. Department of Orthopedic Surgery, University of California, San Francisco, CA, USA

    Benjamin C. Ma

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  1. Luca Facchetti
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  2. Benedikt J. Schwaiger
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Consortia

UCSF-P50-ACL Consortium

AF-ACL Consortium

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Correspondence to Luca Facchetti.

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Facchetti, L., Schwaiger, B.J., Gersing, A.S. et al. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years. Eur Radiol 27, 3499–3508 (2017). https://doi.org/10.1007/s00330-016-4661-3

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  • DOI: https://doi.org/10.1007/s00330-016-4661-3

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