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. 2017 Jan 27;5(1):2325967116684121.
doi: 10.1177/2325967116684121. eCollection 2017 Jan.

Hamstring Contracture After ACL Reconstruction Is Associated With an Increased Risk of Cyclops Syndrome

Francisco Guerra Pinto  1 , Mathieu Thaunat  2 , Matt Daggett  3 , Charles Kajetanek  2 , Tiago Marques  2 , Tales Guimares  2 , Bénédicte Quelard  2 , Bertrand Sonnery-Cottet  2
Affiliations

Hamstring Contracture After ACL Reconstruction Is Associated With an Increased Risk of Cyclops Syndrome

Francisco Guerra Pinto et al. Orthop J Sports Med. .

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] Orthop J Sports Med. 2017 Feb 28;5(2):2325967117697677. doi: 10.1177/2325967117697677. eCollection 2017 Feb. Orthop J Sports Med. 2017. PMID: 28321430 Free PMC article.

Abstract

Background: Cyclops syndrome is characterized by loss of terminal knee extension due to proliferative fibrous nodule formation in the intercondylar notch. This complication occurs in the early postoperative period after anterior cruciate ligament reconstruction (ACLR). The pathogenesis of Cyclops syndrome is not well understood.

Hypothesis: Persistent hamstring contracture after ACLR is associated with an increased risk of subsequent Cyclops syndrome.

Study design: Case-control study; Level of evidence, 3.

Methods: The files of 45 patients who underwent arthroscopic debridement of a Cyclops lesion after ACLR were analyzed. Recorded data included demographic information and technical details of surgery. Preoperative magnetic resonance images were also analyzed, and patients with femoral bone bruising were identified. Passive and active range of motion were recorded in all patients preoperatively and at 3 and 6 weeks after surgery to address the Cyclops lesion. Passive extension deficit was evaluated in comparison with the contralateral limb and classified as secondary to hamstring contracture when contracture was observed and palpated in the prone position and when the extension deficit was reversed after exercises performed to fatigue the hamstrings. A control group was selected using a random numbers table among our entire ACLR cohort. Statistical analysis was performed to analyze differences between the 2 groups.

Results: There was no significant difference between the groups with regard to age at ACLR, sex distribution, time from injury to surgery (P > .05), proportion of professional athletes, presence of femoral bone bruise, or technical aspects of surgery. The overall extension deficit incidence was significantly higher in the Cyclops group at 3 weeks (Cyclops, 71%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 60%; control, 7%) (P < .001). The extension deficit related to hamstring contracture was significantly higher in the Cyclops group at 3 weeks (Cyclops, 58%; control, 22%) (P < .001) and at 6 weeks (Cyclops, 29%; control, 2%) (P < .001).

Conclusion: The Cyclops lesion is associated with a persistent hamstring contracture at 3 and 6 weeks after ACLR.

Keywords: Cyclops syndrome; anterior cruciate ligament; hamstring contracture; knee; knee extension deficit; rehabilitation.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.S.C. is a paid consultant, receives royalties, receives research support, and has made presentations for Arthrex. M.T. is a paid consultant, receives research support, and has made presentations for Arthrex.

Figures

Figure 1.
Figure 1.
Typical extension deficit related to hamstring contracture. (A) The extension deficit can be observed in the prone position. (B) This extension deficit is reversed after resistance exercises to obtain hamstring fatigue. Arrows indicate extension deficit as visualized by the distance between the exam table and the anterior aspect of the ankle.
Figure 2.
Figure 2.
Evolution of extension deficit and hamstrings contracture at 3 and 6 weeks in the control and Cyclops group.
See this image and copyright information in PMC

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