Jean-Romain Delaloye1, Jozef Murar2, Thais D Vieira3, Florent Franck3, Charles Pioger3, Lionel Helfer3, Adnan Saithna4,5, Bertrand Sonnery-Cottet3. 1. Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland. 2. Twin Cities Orthopedics, Edina, Minnesota, USA. 3. Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France. 4. Sano Orthopedics, Overland Park, Kansas, USA. 5. Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA.
Abstract
BACKGROUND: Cyclops syndrome is characterized by a symptomatic extension deficit attributed to impingement of a cyclops lesion within the intercondylar notch. The syndrome is an important cause of reoperation after anterior cruciate ligament reconstruction (ACLR). It has been suggested that remnant-preserving ACLR techniques may predispose to cyclops syndrome, but there is very limited evidence to support this. In general terms, risk factors for cyclops syndrome are not well-understood. PURPOSE: To determine the frequency of and risk factors for reoperation for cyclops syndrome in a large series of patients after ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A retrospective analysis of prospectively collected data was performed, including all patients who underwent primary ACLR between January 2011 to December 2017. Patients undergoing major concomitant procedures were excluded. Demographic data, intraoperative findings (including the size of preserved remnants), and postoperative outcomes were recorded. Those patients who underwent reoperation for cyclops syndrome were identified, and potential risk factors were evaluated in multivariate analysis. RESULTS: A total of 3633 patients were included in the study, among whom 65 (1.8%) underwent reoperation for cyclops syndrome. Multivariate analysis demonstrated that preservation of large remnants did not predispose to cyclops lesions (odds ratio [OR], 1.11; 95% CI, 0.63-1.93). The most important risk factor was extension deficit in the early postoperative period. If present at 3 weeks postoperatively, it was associated with a >2-fold increased risk of cyclops syndrome (OR, 2.302; 95% CI, 1.268-4.239; P < .01), which was increased to 8-fold if present 6 weeks after ACLR (OR, 7.959; 95% CI, 4.442-14.405; P < .0001). None of the other potential risk factors evaluated were found to be significantly associated with an increased frequency of cyclops syndrome. CONCLUSION: Failure to regain full extension in the early postoperative period was the only significant risk factor for cyclops syndrome after ACLR in a large cohort of patients. Other previously hypothesized risk factors, such as preservation of a large anterior cruciate ligament remnant, did not predispose to the development of this debilitating postoperative complication.
BACKGROUND: Cyclops syndrome is characterized by a symptomatic extension deficit attributed to impingement of a cyclops lesion within the intercondylar notch. The syndrome is an important cause of reoperation after anterior cruciate ligament reconstruction (ACLR). It has been suggested that remnant-preserving ACLR techniques may predispose to cyclops syndrome, but there is very limited evidence to support this. In general terms, risk factors for cyclops syndrome are not well-understood. PURPOSE: To determine the frequency of and risk factors for reoperation for cyclops syndrome in a large series of patients after ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A retrospective analysis of prospectively collected data was performed, including all patients who underwent primary ACLR between January 2011 to December 2017. Patients undergoing major concomitant procedures were excluded. Demographic data, intraoperative findings (including the size of preserved remnants), and postoperative outcomes were recorded. Those patients who underwent reoperation for cyclops syndrome were identified, and potential risk factors were evaluated in multivariate analysis. RESULTS: A total of 3633 patients were included in the study, among whom 65 (1.8%) underwent reoperation for cyclops syndrome. Multivariate analysis demonstrated that preservation of large remnants did not predispose to cyclops lesions (odds ratio [OR], 1.11; 95% CI, 0.63-1.93). The most important risk factor was extension deficit in the early postoperative period. If present at 3 weeks postoperatively, it was associated with a >2-fold increased risk of cyclops syndrome (OR, 2.302; 95% CI, 1.268-4.239; P < .01), which was increased to 8-fold if present 6 weeks after ACLR (OR, 7.959; 95% CI, 4.442-14.405; P < .0001). None of the other potential risk factors evaluated were found to be significantly associated with an increased frequency of cyclops syndrome. CONCLUSION: Failure to regain full extension in the early postoperative period was the only significant risk factor for cyclops syndrome after ACLR in a large cohort of patients. Other previously hypothesized risk factors, such as preservation of a large anterior cruciate ligament remnant, did not predispose to the development of this debilitating postoperative complication.
Authors: Kate E Webster; Jerome Murgier; Julian A Feller; Haydn J Klemm; Brian M Devitt; Timothy S Whitehead Journal: Orthop J Sports Med Date: 2021-04-08
Authors: Kyle N Kunze; Evan M Polce; Anil S Ranawat; Per-Henrik Randsborg; Riley J Williams; Answorth A Allen; Benedict U Nwachukwu; Andrew Pearle; Beth S Stein; David Dines; Anne Kelly; Bryan Kelly; Howard Rose; Michael Maynard; Sabrina Strickland; Struan Coleman; Jo Hannafin; John MacGillivray; Robert Marx; Russell Warren; Scott Rodeo; Stephen Fealy; Stephen O'Brien; Thomas Wickiewicz; Joshua S Dines; Frank Cordasco; David Altcheck Journal: Orthop J Sports Med Date: 2021-10-14
Authors: Vitor Barion C de Padua; Adnan Saithna; Eduardo Federighi B Chagas; Tereza Lais M Zutin; Lucas Fernandes Piazzalunga; Luis Fernando Patriarcha; Paulo Jose de Lorenzetti Gelas; Camilo P Helito Journal: Orthop J Sports Med Date: 2021-10-06