LONG-TERM OUTCOME AFTER ARTHROSCOPIC TREATMENT OF CYCLOPE SYNDROME

Abstract

Purpose: Cyclope syndrome is a complication which occurs after ligamentoplasty of the anterior cruciate ligament. It is characterised by permanent flexion which may or not be associated with anterior pain, cracking or hydroarthrosis, typically during exercise. The diagnosis is confirmed by MRI. Arthroscopic treatment is indicated for resection of the nodule and as needed bone plasty of the notch if permanent flexion persists. In the literature, short-term results have been disappointing. We wanted to know more about the long-term outcome.

Material and methods: From January 1992 to December 1994, 835 patients underwent bone-tension plasty. Thirty-six underwent secondary surgery for cyclope syndrome (4.3%). Mean age at revision procedure was 26.2 years (16–43). Most of the subjects were athletes. Twenty-three patients (63.9%) were seen at follow-up consultation and 16.7% responded to a telephone interview. Mean time to review was nine years (8–10 years). We used the IKDC 1999 chart for subjective assessment and clinical evaluation and measured laxity with KT1000. We also studied changes in symptoms related to cyclope syndrome.

Results: We had two cases of recurrent tears (6.9%). The mean final subjective IKDC score was 81.6 points. Half of the patients had good outcome (> 82 points) and half had disappointing results (scored 50–80 points). The final objective IKDC scoring was: A=17.4%, B=65.2%, C=8.7%, D=8.7%. Thirteen patients had persistent signs of cyclope syndrome (44.8%). Fourteen still had limited joint motion (48.3%). Fifteen reduced their physical activity level (51.7%).

Discussion: The origin of the cyclope syndrome remains controversial. It is difficult to assess the risk of recurrent tear due to the small size of the population and the long time to review in this series.

Conclusion: Cyclope syndrome does not appear to be a factor of risk of laxity but is a non-negligible factor of morbidity, even ten years later. It appears to be important to operate early in order to avoid the spiral of chronic suffering. The postoperative flexion, which had been advocated in the past, does not appear to be useful.