Cyclops Lesion

Photo: http://www.kneeguru.co.uk/KNEEnotes/articles/general-articles/2016/cyclops-lesion-after-acl-reconstruction

I learned something new this week!  I was listening to an older episode of Mike Reinold's Podcast, "The Ask Mike Reinold Show," when Lenny Macrina mentioned a Cyclops Lesion, something I had never heard of before.

Of course I immediately googled to get a definition and then hit PubMed for a few articles.  A Cyclops Lesion, also discribed here, nicknamed the Cyclops Lesion for its appearance on imaging is also known as Localized Anterior Arthrofibrosis.  It is basically a build up of scar tissue in the intracondylar region of the femur.  It is a limiting factor in terminal knee extension (TKE) following ACL repair which is important because if TKE is not fully restored, future comorbidities are more likely later down the road.  According to this case study by Dhanda et al, 1-9.8% of patients who have had an ACL reconstruction may experience a cyclops lesion.  Most importantly from this article, "aggressive physical therapy does not improve extension loss associated with cyclops lesion."

I looked into this a little bit further and came across this study from Shelbourne which describes the importance of the relationship between surgeons and physical therapists as well as the key role in ROM symmetry in the knee.  They note that the surgical knee should be within 2* of hyperextension to the non surgical side and within 5* of flexion.  This is a case when symmetry matters, where so often in rehabilitation we allow for asymmetry because this is more natural.

After learning about the Cyclops Lesion, I went to PT Pub Night Seattle and met up with some fellow PTs and surveyed the crew... several had either not heard of or seen this in their practice despite mostly being in orthopedic practice.  I hope the new learning will benefit as much as I anticipate it will help me.  How could this affect my practice?

I definitely have a greater appreciation of the need for symmetry for post op ACL patients and I now know that this exists so that if I encounter issues with ROM, particularly achieving and sustaining terminal knee extension beyond around 8 weeks post op, I need to refer back to the surgeon with concerns.  Hopefully this will help others who may be unfamiliar with this condition.