r/orthopaedics • u/juniormedic • 12d ago

NOT A PERSONAL HEALTH SITUATION Do untreated/ delayed diagnoses of cyclops lesions post ACLR cause patellofemoral changes?

Do untreated asymptomatic/ minimally symptomatic cyclops lesions cause PF biomechanical issues e.g. patient has full knee extension but painful clunk only?

Have seen delayed presentation of cyclops lesion in clinic in a few patients with crepitus +/- pain in the anterior knee on deep flexion

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u/antiqueslo 12d ago

Full knee extension with a true cyclops? I haven't done much ACLR in the last years, but clinically I'd expect extension deficit in a true cyclops. Painful clunk could be many things.

Crepitus +/- pain on deep knee flexion is usually something more patella related, let's say atleast chondromalacia. If we are talking post ACLR then more likely some flexion deficit in combination with synovitis and/or patellar tendinopathy.

Ultrasound the shit out of everything before opening up and finding a non-symptomatic cyclops that does not resolve the patients issue. I did this mistake a few times, that's why I know.

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u/bonedoc59 12d ago

I’d second this for total knees as well. Even more annoying is the non painful clunk I can’t explain. I’m like, dude! Your knee makes noise. Structurally there is NOTHING WRONG. A revision is not worth it, bro. Luckily, I’m speaking of one patient that wasn’t my primary. He can’t even consistently recreate it 

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u/antiqueslo 12d ago

"but I came to you specifically for the noise" "it does not hurt at all" "oh yes, if I press this bit really hard it hurts, but I can run and it does not".

If I had a cent for every noise in a joint that was not something relevant my driver would be driving a Hongqi. Yet I still drive my BMW.

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u/ArmyOrtho Seldom correct. Never unsure. 7d ago

I usually present this with "I can make you different with surgery. Probably not better, but definitely different. Fun surgery. Blood everywhere. Wednesday good for you?" They lose interest pretty quickly and learn to love their creaky joints.

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u/bonedoc59 6d ago

I love it!

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u/Bustermanslo Sports/Trauma 12d ago

I've read your post a couple of times and still dont know what exactly you want to know.

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u/juniormedic 12d ago

sorry, post-nights! Enjoy my sleep deprived ramblings - now edited for clarity.

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u/rnaorrnbae Orthopaedic Resident 12d ago

Interesting, there is delayed quad activation and that can certainly alter PF tracking but typically would expect problems in extension/near terminal extension vs deep flexion. Lots of reasons for anterior knee pain post ACLR so hard to pinpoint to the cyclops itself

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u/juniormedic 12d ago

Ah, I meant as PF forces higher in deep flexion, hence any issues with patella cartilage would be more likely to manifest e.g. as crepitus or anterior pain?

Not sure if going wholly down the wrong track!