Rougereau Grégoire, Rollet Marie Eva, Pascal-Moussellard Hugues, Granger Benjamin, Khiami Frédéric
Département de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, AP-HP, Université de la Sorbonne, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Département de chirurgie orthopédique et traumatologique, Hôpital de la Pitié-Salpêtrière, AP-HP, Université de la Sorbonne, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Orthop Traumatol Surg Res. 2025 Apr;111(2):103918. doi: 10.1016/j.otsr.2024.103918. Epub 2024 Jun 12.
Cyclops syndrome is loss of terminal knee extension caused by a fibrous nodule developed in the anterior intercondylar notch. The many known risk factors include preoperative motion-range limitation, tibial tunnel malposition, and tight hamstrings. The primary objective of this study was to assess whether intercondylar notch size was associated with the risk of cyclops syndrome or graft tear after anterior cruciate ligament (ACL) reconstruction using a quadruple semi-tendinosis autograft. The secondary objective was to determine whether intercondylar notch size was associated with functional outcomes.
A narrow intercondylar notch is associated with higher risks of cyclops syndrome and poor functional outcomes.
Consecutive patients who underwent ACL reconstruction by quadruple semi-tendinosus autograft were included retrospectively. Preoperative magnetic resonance imaging scans were assessed by a single senior surgeon, who determined the conventional notch width index (NWI) and the anterior NWI (aNWI) for each patient.
The 120 included patients had a mean follow-up of 2.4±0.8 years. Among them, 20 (16.7%) experienced cyclops syndrome and 7 (5.8%) graft rupture. At last follow-up, 26 (21.7%) had not returned to sports and only 47 (39.2%) had returned to sports at the pre-injury level. The mean Lysholm score was 87.9±13.5 and the main subjective IKDC score was 84±13. A narrow notch was significantly associated with lower likelihoods of returning to sports (p=0.001), returning to the same sport (p<0.0001), and returning to the pre-injury sport level (p=0.004). By multivariate analysis, only the aNWI index was significantly associated with the risk of cyclops syndrome (p<0.0001). An aNWI index lower than 0.18 had 85% sensitivity and 78% specificity for predicting cyclops syndrome.
A narrow anterosuperior intercondylar notch may increase the risk of cyclops syndrome after ACL reconstruction using a quadruple semi-tendinosus graft but is not associated with the risk of graft rupture.
IV, retrospective observational cohort study.
“独眼巨人综合征”是指因髁间前切迹处形成纤维性结节导致膝关节终末伸展功能丧失。众多已知的风险因素包括术前活动范围受限、胫骨隧道位置不当以及腘绳肌紧张。本研究的主要目的是评估髁间切迹大小是否与使用四股半腱肌自体移植物进行前交叉韧带（ACL）重建后发生“独眼巨人综合征”或移植物撕裂的风险相关。次要目的是确定髁间切迹大小是否与功能结局相关。
狭窄的髁间切迹与“独眼巨人综合征”的较高风险及不良功能结局相关。
回顾性纳入连续接受四股半腱肌自体移植物ACL重建的患者。由一位资深外科医生评估术前磁共振成像扫描，确定每位患者的传统切迹宽度指数（NWI）和前切迹宽度指数（aNWI）。
纳入的120例患者平均随访2.4±0.8年。其中，20例（16.7%）发生“独眼巨人综合征”，7例（5.8%）移植物破裂。在末次随访时，26例（21.7%）未恢复运动，仅47例（39.2%）恢复到受伤前的运动水平。Lysholm评分平均为87.9±13.5，主观IKDC主要评分为84±13。狭窄切迹与恢复运动（p=0.001）、恢复同一项运动（p<0.0001）以及恢复到受伤前运动水平（p=0.004）的可能性较低显著相关。通过多因素分析，仅aNWI指数与“独眼巨人综合征”风险显著相关（p<0.0001）。aNWI指数低于0.18对预测“独眼巨人综合征”的敏感性为85%，特异性为78%。
狭窄的髁间前上切迹可能会增加使用四股半腱肌移植物进行ACL重建后发生“独眼巨人综合征”的风险，但与移植物破裂风险无关。
IV级，回顾性观察队列研究。
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