前交叉韧带重建术后Cyclops综合征的诊疗模式、争议及拟定的处理流程：一项国际调查
简介
一项针对250名国际膝关节外科医生的调查显示，ACL术后Cyclops综合征的发生率估计为1%-5%，典型症状在术后3-6个月内出现，伸直受限超过5°是关键体征。MRI是首选诊断手段，预防重点在于胫骨骨道精准定位和术前充分伸直；初始治疗以伸膝康复为主，保守无效时行关节镜下病灶切除效果良好。该研究提出了一个分步管理流程，强调早期识别伸直受限、选择性影像检查和阶…
英文摘要
PURPOSE: Cyclops syndrome remains a clinically relevant cause of extension deficit after anterior cruciate ligament reconstruction (ACLR), yet its prevention, diagnosis, and management are not standardized. The purpose of this study was to characterize practice patterns, identify areas of consensus and controversy, and derive a clinically applicable management framework based on an international survey of knee surgeons. METHODS: A 69-item online survey was distributed to orthopaedic surgeons specialized in knee surgery through multiple international societies. The questionnaire explored five domains: surgeon characteristics, surgical techniques, preventive strategies, diagnostic approaches, and management of cyclops syndrome. Descriptive statistics were used to summarize responses. RESULTS: A total of 250 surgeons from 25 countries completed the survey. Most respondents estimated the incidence of cyclops syndrome between 1% and 5%, with symptomatic presentation typically occurring within 3-6 months after ACLR. Loss of extension greater than 5° was consistently identified as the key clinical finding. Magnetic resonance imaging was the preferred first-line diagnostic modality. Despite heterogeneity in several aspects of care, consistent patterns emerged. Accurate tibial tunnel positioning and restoration of full preoperative knee extension were considered the most critical preventive factors. Initial management was predominantly conservative, with most surgeons advocating an extension-focused rehabilitation trial before surgical intervention. Arthroscopic excision was generally reserved for persistent extension deficits and was associated with favorable outcomes and low recurrence rates. However, substantial variability persisted regarding the role of remnant preservation, timing of surgery, and indications for imaging, highlighting unresolved clinical controversies. CONCLUSIONS: While substantial variability exists in the management of cyclops syndrome after ACLR, consistent clinical patterns can be identified. Based on these findings, a stepwise management approach can be proposed, emphasizing early recognition of extension deficit, selective use of imaging, and a staged treatment strategy. These results provide a foundation for future efforts toward consensus guidelines and standardized care pathways. LEVEL OF EVIDENCE: Level V, cross-sectional survey study.