Nicky van Melick, Rob Jansen & Rob Bogie

Influence of female sex and double-quadruple semitendinosus-gracilis graft on the incidence of postoperative symptomatic cyclops lesions after ACL reconstruction.

Risk factors for developing a cyclops lesion after anterior cruciate ligament reconstruction (ACLR) are still unclear. Therefore, we investigated which factors contribute to this.

In total, we reviewed the records of 1416 patients who underwent ACLR at the Anna Hospital Geldrop or the Maxima Medical Center Eindhoven. All patients recieved a hamstring graft. For most patients, the graft was made from tendon of the semitendinosus (ST) only. This tendon is folded several times to create a graft with a diameter of 8 mm or more. As a result, the new ligament usually has 3 or 4 bundles. Sometimes, the gracilis is added to the semitendinosus (STG) to create a ligament that is thick enough. This graft then will have 6 or 8 bundles.

Patients who returned to the orthopedic surgeon within the first two years after surgery with limited extension of the knee or painful extension underwent an MRI to determine if a cyclops lesion was present. In total, 46 out of 1416 patients (3.2%) developed a cyclops lesion. All patients, except 2, had a cyclops-removing surgery.

We found that patients with an 8-bundle ligament (a so-called double-quadruple graft) had a higher risk of developing a cyclops lesion, namely 8.3%. All other bundle numbers had an average risk of developing a cyclops of 3.0%.

Additionally, we found that women have a 2.5 times higher risk of developing a cyclops. However, this may be because women more often receive such an 8-bundle ligament than men.

Reference: Arens T, van Melick N, van der Steen MC, Janssen RPA, Bogie R.

Influence of female sex and double-quadruple semitendinosus-gracilis graft on the incidence of postoperative symptomatic cyclops lesions after ACL reconstruction.

Knee Surg Sports Traumatol 2024, online ahead of print.