Practice patterns, controversies, and proposed management algorithm for cyclops syndrome after anterior cruciate...

Area of Science:

• Orthopaedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Cyclops syndrome is a common complication after anterior cruciate ligament reconstruction (ACLR), causing significant extension deficits.
• Current prevention, diagnosis, and management strategies lack standardization, leading to inconsistent patient care.

Purpose of the Study:

• To survey international knee surgeons on their practices regarding cyclops syndrome.
• To identify consensus and controversial areas in cyclops syndrome management.
• To develop a framework for clinical management of cyclops syndrome post-ACLR.

Main Methods:

• An online survey with 69 items was distributed to 250 orthopaedic surgeons specializing in knee surgery across 25 countries.
• The survey covered surgeon demographics, surgical techniques, prevention, diagnosis, and management of cyclops syndrome.
• Descriptive statistics were used to analyze the collected data.

Main Results:

• Most surgeons estimate cyclops syndrome incidence at 1-5%, typically presenting 3-6 months post-ACLR.
• Loss of extension >5° is the primary diagnostic indicator; MRI is the preferred imaging modality.
• Accurate tibial tunnel placement and restoring full extension are crucial for prevention. Conservative management with rehabilitation is favored initially, with arthroscopic excision for persistent cases.

Conclusions:

• Despite practice variations, consistent patterns in cyclops syndrome management exist.
• A stepwise approach involving early deficit recognition, judicious imaging, and staged treatment is proposed.
• These findings can inform future consensus guidelines and standardized care pathways for ACLR patients.