Abstract
Objectives:
Several factors have been implicated in the development of cyclops lesions after anterior cruciate ligament reconstruction (ACLR), including patient sex, concomitant meniscus repair, and graft choice (namely patellar tendon and quadriceps tendon autografts). However, the impact of surgical characteristics such as graft diameter, notch size, and remnant preservation on rates of cyclops lesions following ACLR remain poorly understood. Therefore, the purpose of this study was to determine patient and surgical factors associated with the development of symptomatic cyclops lesion following ACLR.
Methods:
A retrospective review was conducted of all primary ACLR performed between 2014 and 2021 at a large integrated health care system with minimum 1-year follow-up. Primary outcome was incidence of symptomatic cyclops lesions, defined as those requiring re-operation for cyclops debridement. Data regarding patient age, sex, BMI, primary ACLR graft type, and concomitant meniscal procedures were collected. Intra-operative variables evaluated included stump preservation (graded as above or below the level of the tibial spine) and significant graft contact or impingement with the lateral femoral condyle (LFC). Additional variables included graft diameter (grouped as >9 mm versus ≤9 mm), notch width (grouped as >15 mm versus ≤15 mm), and posterior tibial slope (PTS; grouped as >12º versus ≤12º). Variables were compared between patients that developed cyclops lesions post-operatively and those that did not.
Results:
A total of 842 patients (mean age: 25.2 years, 48.8% female) undergoing primary ACLR were included, comprising 174 hamstring tendons (HT), 230 quadriceps tendons (QT), 231 bone-patellar tendon-bone (BTB), and 207 allografts (AG). The overall rate of cyclops lesions was 6.5%. Graft type during primary ACLR (HT: 6.3%, QT: 6.1%, BTB: 7.8%, AG: 5.3%; p = 0.755) and presence of concomitant meniscus procedure (6.4% vs 6.4%; p = 0.985) were not associated with development of cyclops lesion. Additionally, ACL stump preservation above versus below the tibial spine (3.4% vs 6.0%; p = 0.214) and graft contact with the LFC (2.4% vs 5.7%; p = 0.140) were not associated with development of cyclops lesion. Graft diameter >9 mm was associated with an increased rate of cyclops lesions (7.7% vs 4.2%; p = 0.042), however no difference was observed with regard to notch size <15 mm (15.6% vs 10.3%; p = 0.294) or notch-graft diameter ratio (p = 0.699). PTS >12º was also found to be significantly associated with increased rates of cyclops lesions (19.4% vs 9.3%; p = 0.034).
Conclusions:
Data from this study indicate that graft diameter >9 mm and posterior tibial slope >12º were associated with increased rates of cyclops lesions requiring re-operation following ACLR. Graft type was not found to influence rates of cyclops lesions, with equivalent rates observed between hamstring, quadriceps, patellar tendon, and allograft types. Surgeons may consider these findings when discussing graft size and tibial slope in preoperative shared decision making with their patients.