Surgical Excision of a Cyclops Lesion After ACL Reconstruction in an Elite College Athlete

Cyclops lesion after anterior cruciate ligament (ACL) reconstruction can appear on magnetic resonance imaging (MRI) in up to 30% of patients and is symptomatic in up to 9%. Arthroscopic cyclops removal can help restore motion and limit recurrence.

Patient is an 18-year-old male high-level collegiate athlete with a mechanical block to full extension. Patient underwent ACL reconstruction with bone-patellar tendon-bone autograft 15 months prior by an outside physician. The patient had a stable Lachman and pivot-shift examination, but there was a palpable clunk when attempting to extend his knee the final 10°. Patient was unable to perform sport due to symptoms. Postoperative MRI demonstrated a large cyclops lesion.

Bilateral ligamentous examination under anesthesia was performed prior to draping. Standard arthroscopy portals were used. Diagnostic arthroscopy was performed by assessing all critical structures in the knee (ie, meniscus, cartilage, and ligaments). The cyclops lesion was visualized in the intercondylar notch with clear evidence of superior notch impingement with knee extension. Using a standard shaver and radiofrequency ablation, the cyclops lesion was resected with care not to injure the ACL graft or disrupt its integrity. A small superior soft tissue resection was then performed with resection of scar tissue that had formed within the notch. A repeat examination with an arthroscope in the knee revealed no further impingement.

Patient was able to return fully to sport at 8 weeks postoperatively with no limitations, with no return of clicking or loss of motion.

Symptomatic cyclops lesion after ACL reconstruction can be effectively treated with arthroscopic debridement. Postoperatively, patients can return to full sport at 6 to 8 weeks.

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