2025 ISAKOS Biennial Congress Paper
The Addition of a Lateral Extra-Articular Procedure to a Primary Anterior Cruciate Ligament Reconstruction Is Associated with an Increased Rate of Further Surgery for Cyclops Lesions and Restricted Range of Motion
Timothy Voskuijl, MD, Voorburg NETHERLANDS
Kate E. Webster, PhD, Bundoora, Victoria AUSTRALIA
Timothy S. Whitehead, MBBS, FRACS, Richmond, VIC AUSTRALIA
Haydn Klemm, BFSc&Nutr (Hons), Richmond, VIC AUSTRALIA
Lachlan Batty, FRACS, Melbourne, VIC AUSTRALIA
Julian A. Feller, FRACS, FAOrthA, Melbourne, VIC AUSTRALIA
OrthoSport Victoria, Melbourne, Victoria, AUSTRALIA
FDA Status Not Applicable
Summary
This large cohort study finds an increased rate of subsequent surgical interventions for a restricted range of motion or a symptomatic cyclops lesion in patients who had a LEAP additional to primary ACL reconstruction compared to those who did not.
Abstract
Background
There has been a resurgence in the use of a lateral extra-articular procedure (LEAP) in association with anterior cruciate ligament (ACL) reconstruction to reduce the risk of graft failure. However, there is limited data regarding the morbidity associated with the addition of a LEAP.
Purpose/Hypothesis:
The aim of this study was to examine whether the use of a LEAP in the setting of a primary ACL reconstruction was associated with an increased rate of further surgical intervention for loss of range of motion or a symptomatic cyclops lesion, or with a knee extension deficit.
Methods
1076 patients aged less than 30 who received a primary hamstring tendon (HT) or quadriceps tendon (QT) autograft ACL reconstruction over a 5-year period from January 2016 were evaluated. Rates of the addition of a modified Ellison procedure increased from 0% in 2016 to 51% in 2021. Rates of surgical intervention for loss of motion or a symptomatic cyclops lesion during the first year after surgery, as well as knee extension deficit at 12 months were compared between LEAP and no-LEAP patients. Contingency analyses with risk ratios (RR) were calculated.
Results
17.3% (186/1076) of the patients had an additional LEAP. Of this group, 8.1% required further surgery for restricted motion or a cyclops lesion in the first year after surgery, compared to 3.8% in the no-LEAP group (RR 2.1, p=0.012). This difference was more marked for patients who received a QT graft (13.2% vs 3.2%, RR = 4.1, p=0.019), compared to patients treated with a HT graft (6.8% vs 3.9%, RR = 1.8, p=0.122). There was no significant difference in extension deficit at twelve months between patients with a LEAP (mean 1.02 ± SD 2.6 degrees) and those without (mean 0.97 ± SD 2.4 degrees).
Conclusion
Surgical intervention for a loss of range of motion or symptomatic cyclops lesion in the first postoperative year after primary ACL reconstruction was more common in patients who had an additional LEAP than in those who did not. The higher intervention rate was more apparent in patients who had a QT graft ACL reconstruction.