Cyclops lesions after ACL reconstruction using either bone-tendon-bone autograft or hamstring autograft: A retrospective cohort study

Background: ACL reconstruction is commonly performed with either bone-patellar tendon-bone (BPTB) autograft or hamstring autograft, each of which has inherent advantages and disadvantages; to our knowledge, no study has compared the frequency of cyclops lesions between the two autografts. By focusing on cyclops lesions, a source of knee extension loss after ACL reconstruction, we aimed to expand the comparison between these two autograft options. Methods: A single-center, retrospective chart review identified 1,902 patients between the ages of 8 and 66 yr who had ACL reconstruction between January 1, 2000, and October 31, 2015. Of these, 1534 received a BPTB autograft and 368 a hamstring autograft. Cyclops lesions were confirmed by a second arthroscopy in patients treated for loss of full knee extension, and the occurrences with BPTB and hamstring autograft were compared. Results: Cyclops lesions occurred in 14 (0.91%) of 1,534 reconstructions with BPTB autografts and five (1.35%) of 368 with hamstring autografts (P=0.39); this difference was not statistically significant. Cyclops lesions occurred in five (0.44%) of 1125 males and 14 (1.44%) of 777 females (P=0.004). This was statistically significant, illustrating a more frequent occurrence of cyclops lesions in female patients than in male patients with a relative risk of 4 (CI 1.4-11). Conclusions: Bone-patellar tendon-bone and hamstring autografts both are viable options for ACL reconstruction. The occurrence of cyclops lesions is a potential complication that has not been previously compared between these two graft options. We found no statistically significant difference in the frequency of cyclops lesions between the two groups, minimizing any concern for an increased risk of a cyclops lesion when choosing BPTB autograft or hamstring autograft. Surgeons should be cognizant that the relative risk of a cyclops lesion is four times higher in female patients than in male patients with either graft.