When I think of the word “cyclops”, it may be a dream for an adult, but it is a dream for a physiotherapist. When patients undergo anterior cruciate ligament (ACL) surgery, they have difficulty achieving full knee extension (straight). This may be the cause of the so-called “Cyclops Lesion”.

So what is a Cyclops Lesion?

Pathology was first described in patients by Jackson and Schaefer after ACL reconstructive surgery in 1990 and is now a well-known phenomenon. A lesion is a focal intervertebral articular fibrosis made up of fibrous tissue and may or may not have cartilage and bone segments. It occurs at the top of the graph and in the intercondylar fissure between the femur and tibia. Simply put, the scar tissue on the front of the knee completely prevents straightening.

How are you progressing?

Cyclops lesions are loss of extended knee extension, often approximately 2-3 months after ACL surgery. However, this can be a problem for years after the operation. This is not a big loss of detail, often less than 10 degrees, but it is enough for the problem. Pain in the front of the knee is usually associated with this limited movement and may include the sound of cracking. The patient also usually has a quadriceps muscle disorder.

Why does this happen?

There are some competitive theories as to why wound tissue grows. Jackson and Schaefer suggested that the problem was caused by debris in the knee joint, a table tunnel drill or debris from ACL graft fibres. It has been suggested that these wastes cause granulation tissue formation. This has been debated ever since, although surgeons have been able to reduce the incidence of cyclops lesion by leaving a small dent in the joints after surgery. It has also been suggested that the cyclops lesion was caused by a graft when the knee was fully extended, causing cyclops lesion tissue to form. Whatever the reason, the current evidence suggests that it is not the fault of the patient or the doctor. The development of cyclops lesions is a multifaceted process and difficult to predict.

Cyclops lesion without surgery?

Although rarely known, it is possible for patients who have experienced ACL trauma to develop cyclops lesions without surgery. The procedure is assumed to be the same after the operational presentation, which means that every patient should suspect a reduction in pressure after an ACL injury.

Risk Factors

1. Female sex due to narrow spines
2. Make the graft size higher than the cherry size.
3. Anterior cruciate ligament osteotomy of the tibia
4. Resurfacing of the anterior cruciate ligament of the femur
5. The next location of the table tunnel
6. Double bundle inner cruciate ligament reconstruction due to the large volume of the graph.
7. Pericarditis arthroplasty due to severe posterior cruciate ligament or tabular island injury.
8. Hamstring compression

What can you do about it?

Unfortunately, physical therapy has not been able to help with the major injury. No matter how hard you and your doctor try to straighten the knee, it won’t work. Then a second arthroscopy is needed to remove the scar tissue nodules to restore the extension.

If Cyclops is suspected, you will need to see your orthopaedic surgeon and have an MRI to confirm the presence of scar tissue. MRI is 84% accurate in detecting cyclops lesions, and surgical intervention usually successfully restoring knee function.

Here is a Case presentation to know more about cyclops lesion.

A 26-year-old patient underwent MCL repairs on June 21, 2019, and had his anterior cruciate ligament (patellar condyle) reconstructed. After four months (October 31, 2019), her knee part became swollen and stiff for the last two months. However, the inflammation persisted for seven months after ACL reconstruction surgery. MRI was performed to assess the cause of knee stiffness and persistent swelling. A heterozygous intermediate signalling lesion was found in the posterior spiral fissure near the cyclops lesion, presumably the Hoof fat cushion. Reconstruction of the upper and posterior cruciate ligament appears satisfactory on MRI. There was also a long brain of collateral peroneal ligament and hamstring tendons, as seen on MRI.

On arthroscopy, the lesion appears as a group of soft tissue on the head with a red focal area. The sample was sent to the laboratory, and histopathological examination revealed the presence of fibrocartilage tissue. Based on the medical examination, radiographic and endoscopic features, and histopathological examination, the final diagnosis of this patient was a left knee cyclops injury. Laparoscopic resection is recommended to remove the cyclops lesion. After excision, physiotherapy was performed by the patient for normal knee joint movement. The patient received a full extension within three months of follow-up and was very happy with the result.

What is ACL debridement?

Osteoarthritis is the most common type of joint that affects the knee and other joints of the shoulder, intestines, legs and feet. Articular cartilage cushions the joints so that there is a smooth and painless movement between the bones in the joints. In this case, the muscle glands are destroyed, which causes the ends of the bones to swell, causing pain and swelling.

Other symptoms include limited knee movement, muscle stiffness, and redness and warmth around the joints.

Your doctor will perform a physical examination to see the joints’ swelling, tenderness, and limited movement. X-rays of the affected joints can be taken to look for damage to the joint.

Surgery may be considered the ultimate treatment option if conservative therapies such as medication and physical therapy are not comfortable.

Arthroscopic debridement cleaning is a surgical procedure performed using an arthroscope. In this procedure, the damaged ligament or bone is surgically removed, and the meniscus edges are cut. Joint cleaning is done using a special tool that sprays a liquid jet to wash and absorb the remaining debris around the joint. Any residual items or pieces are removed after washing. Exfoliation helps reduce pain and slow the growth of joints. If you are still experiencing pain and other symptoms due to the underlying cause of the joints, dehydration may recur. After endoscopic decompression, you can return to sports and other activities much faster than traditional methods.

Conclusion

Finally, it is important to determine the underlying cause of knee extension damage, especially in any cyclops lesion with an ACL injury. A large temple injury can be easily treated with an arthroscopic resection procedure, and satisfactory results will be achieved later.