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Cyclops Lesions That Occur in the Absence of Prior Anterior Ligament Reconstruction¹

¹ From the Departments of Radiology (B.R.R., L.W.B., J.J.P., M.J.K., T.H.B) and Orthopedic Surgery (C.J.O.), Mayo Clinic, 4500 San Pablo Blvd, Jacksonville, Fla 32224. Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received April 30, 2007; revision requested June 20; revision received and accepted July 27. All authors have no financial relationship to disclose.

View larger version (159K): [in this window] [in a new window] [Download PPT slide]   Figure 1a.  Posttrauma cyclops lesion in a 31-year-old woman with a chronic ACL tear and repaired tibial plateau fracture after skiing accident 1 year before. (a) Axial proton-density fat-suppressed image (repetition time msec/echo time msec, 3000/25) demonstrates intermediate-intensity cyclops nodule (arrow) in the intercondylar notch, joint effusion, and a popliteal cyst. (b) Sagittal proton-density image (3000/25) shows a slightly heterogeneous cyclops nodule (arrow) anterior to the ACL attachment. (c, d) Correlative arthroscopic images demonstrate the proximally torn ACL (arrow) and the cyclops lesion (*) (c) before and (d) during elevation by the probe.

 

View larger version (178K): [in this window] [in a new window] [Download PPT slide]   Figure 1b.  Posttrauma cyclops lesion in a 31-year-old woman with a chronic ACL tear and repaired tibial plateau fracture after skiing accident 1 year before. (a) Axial proton-density fat-suppressed image (repetition time msec/echo time msec, 3000/25) demonstrates intermediate-intensity cyclops nodule (arrow) in the intercondylar notch, joint effusion, and a popliteal cyst. (b) Sagittal proton-density image (3000/25) shows a slightly heterogeneous cyclops nodule (arrow) anterior to the ACL attachment. (c, d) Correlative arthroscopic images demonstrate the proximally torn ACL (arrow) and the cyclops lesion (*) (c) before and (d) during elevation by the probe.

 

View larger version (56K): [in this window] [in a new window] [Download PPT slide]   Figure 1c.  Posttrauma cyclops lesion in a 31-year-old woman with a chronic ACL tear and repaired tibial plateau fracture after skiing accident 1 year before. (a) Axial proton-density fat-suppressed image (repetition time msec/echo time msec, 3000/25) demonstrates intermediate-intensity cyclops nodule (arrow) in the intercondylar notch, joint effusion, and a popliteal cyst. (b) Sagittal proton-density image (3000/25) shows a slightly heterogeneous cyclops nodule (arrow) anterior to the ACL attachment. (c, d) Correlative arthroscopic images demonstrate the proximally torn ACL (arrow) and the cyclops lesion (*) (c) before and (d) during elevation by the probe.

 

View larger version (57K): [in this window] [in a new window] [Download PPT slide]   Figure 1d.  Posttrauma cyclops lesion in a 31-year-old woman with a chronic ACL tear and repaired tibial plateau fracture after skiing accident 1 year before. (a) Axial proton-density fat-suppressed image (repetition time msec/echo time msec, 3000/25) demonstrates intermediate-intensity cyclops nodule (arrow) in the intercondylar notch, joint effusion, and a popliteal cyst. (b) Sagittal proton-density image (3000/25) shows a slightly heterogeneous cyclops nodule (arrow) anterior to the ACL attachment. (c, d) Correlative arthroscopic images demonstrate the proximally torn ACL (arrow) and the cyclops lesion (*) (c) before and (d) during elevation by the probe.

 

View larger version (160K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.  Cyclops lesion in a 45-year-old-man with 2-year history of chronic ACL tear and loss of extension.(a) Sagittal FSE proton-density image demonstrates the well-circumscribed, slightly heterogeneous cyclops nodule. (b) Coronal DESS image demonstrates a soft-tissue nodule in the anterior intercondylar notch.

 

View larger version (137K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.  Cyclops lesion in a 45-year-old-man with 2-year history of chronic ACL tear and loss of extension.(a) Sagittal FSE proton-density image demonstrates the well-circumscribed, slightly heterogeneous cyclops nodule. (b) Coronal DESS image demonstrates a soft-tissue nodule in the anterior intercondylar notch.

 

View larger version (180K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  Posttrauma cyclops nodule in a 41-year-old-man with chronic ACL tear after hyperextension 2 years before. (a) Coronal T1-weighted image through the intercondylar notch shows a well-circumscribed nodule (arrow) isointense to skeletal muscle. (b) Coronal DESS image demonstrates cyclops lesion (arrow) that is heterogeneously hyperintense to muscle.

 

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  Posttrauma cyclops nodule in a 41-year-old-man with chronic ACL tear after hyperextension 2 years before. (a) Coronal T1-weighted image through the intercondylar notch shows a well-circumscribed nodule (arrow) isointense to skeletal muscle. (b) Coronal DESS image demonstrates cyclops lesion (arrow) that is heterogeneously hyperintense to muscle.

 

View larger version (193K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.  Cyclops nodule in an atypical position, lateral to the anterior intercondylar notch, in a 67-year-old woman with normal ACL and history of trauma four months before with partial meniscectomy. Sagittal FSE proton-density (a) and FSE T2-weighted (b) images slightly lateral to the anterior intercondylar notch demonstrate a heterogeneous nodule (arrow) abutting the anterior horn of the lateral meniscus.

 

View larger version (189K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.  Cyclops nodule in an atypical position, lateral to the anterior intercondylar notch, in a 67-year-old woman with normal ACL and history of trauma four months before with partial meniscectomy. Sagittal FSE proton-density (a) and FSE T2-weighted (b) images slightly lateral to the anterior intercondylar notch demonstrate a heterogeneous nodule (arrow) abutting the anterior horn of the lateral meniscus.

 

View larger version (182K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.  Posttrauma cyclops lesion in a 27-year-old woman with a high-grade partial-thickness ACL tear and loss of extension. (a) Sagittal FSE T2-weighted image demonstrates a complete tear of the ACL (arrow), which was later characterized as a high-grade partial-thickness tear at arthroscopy. (b) Coronal FSE T2-weighted image shows a small cyclops nodule (arrow) in the anterior intercondylar notch. Note the lateral femoral condylar bone contusion and associated medial collateral ligament tear. (c-e) Arthroscopic images show the well-defined cyclops nodule (arrow) protruding from the anteromedial bundle of the ACL (c) before, (d) during, and (e) after debridement. (f) Histomicrograph at low power demonstrates fibroblastic and fibrotendinous areas throughout the central portion of the section, with neovascularity (arrowheads). (Hematoxylin-eosin stain; original magnification, x10.) (g) Histomicrograph at high power demonstrates small foci of hemosiderin (arrow) and blood vessels (arrowheads) within a matrix of fibrotendinous tissue. (Hematoxylin-eosin stain; original magnification, x40.)

 

View larger version (177K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.  Posttrauma cyclops lesion in a 27-year-old woman with a high-grade partial-thickness ACL tear and loss of extension. (a) Sagittal FSE T2-weighted image demonstrates a complete tear of the ACL (arrow), which was later characterized as a high-grade partial-thickness tear at arthroscopy. (b) Coronal FSE T2-weighted image shows a small cyclops nodule (arrow) in the anterior intercondylar notch. Note the lateral femoral condylar bone contusion and associated medial collateral ligament tear. (c-e) Arthroscopic images show the well-defined cyclops nodule (arrow) protruding from the anteromedial bundle of the ACL (c) before, (d) during, and (e) after debridement. (f) Histomicrograph at low power demonstrates fibroblastic and fibrotendinous areas throughout the central portion of the section, with neovascularity (arrowheads). (Hematoxylin-eosin stain; original magnification, x10.) (g) Histomicrograph at high power demonstrates small foci of hemosiderin (arrow) and blood vessels (arrowheads) within a matrix of fibrotendinous tissue. (Hematoxylin-eosin stain; original magnification, x40.)

 

View larger version (75K): [in this window] [in a new window] [Download PPT slide]   Figure 5c.  Posttrauma cyclops lesion in a 27-year-old woman with a high-grade partial-thickness ACL tear and loss of extension. (a) Sagittal FSE T2-weighted image demonstrates a complete tear of the ACL (arrow), which was later characterized as a high-grade partial-thickness tear at arthroscopy. (b) Coronal FSE T2-weighted image shows a small cyclops nodule (arrow) in the anterior intercondylar notch. Note the lateral femoral condylar bone contusion and associated medial collateral ligament tear. (c-e) Arthroscopic images show the well-defined cyclops nodule (arrow) protruding from the anteromedial bundle of the ACL (c) before, (d) during, and (e) after debridement. (f) Histomicrograph at low power demonstrates fibroblastic and fibrotendinous areas throughout the central portion of the section, with neovascularity (arrowheads). (Hematoxylin-eosin stain; original magnification, x10.) (g) Histomicrograph at high power demonstrates small foci of hemosiderin (arrow) and blood vessels (arrowheads) within a matrix of fibrotendinous tissue. (Hematoxylin-eosin stain; original magnification, x40.)

 

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 5d.  Posttrauma cyclops lesion in a 27-year-old woman with a high-grade partial-thickness ACL tear and loss of extension. (a) Sagittal FSE T2-weighted image demonstrates a complete tear of the ACL (arrow), which was later characterized as a high-grade partial-thickness tear at arthroscopy. (b) Coronal FSE T2-weighted image shows a small cyclops nodule (arrow) in the anterior intercondylar notch. Note the lateral femoral condylar bone contusion and associated medial collateral ligament tear. (c-e) Arthroscopic images show the well-defined cyclops nodule (arrow) protruding from the anteromedial bundle of the ACL (c) before, (d) during, and (e) after debridement. (f) Histomicrograph at low power demonstrates fibroblastic and fibrotendinous areas throughout the central portion of the section, with neovascularity (arrowheads). (Hematoxylin-eosin stain; original magnification, x10.) (g) Histomicrograph at high power demonstrates small foci of hemosiderin (arrow) and blood vessels (arrowheads) within a matrix of fibrotendinous tissue. (Hematoxylin-eosin stain; original magnification, x40.)

 

View larger version (79K): [in this window] [in a new window] [Download PPT slide]   Figure 5e.  Posttrauma cyclops lesion in a 27-year-old woman with a high-grade partial-thickness ACL tear and loss of extension. (a) Sagittal FSE T2-weighted image demonstrates a complete tear of the ACL (arrow), which was later characterized as a high-grade partial-thickness tear at arthroscopy. (b) Coronal FSE T2-weighted image shows a small cyclops nodule (arrow) in the anterior intercondylar notch. Note the lateral femoral condylar bone contusion and associated medial collateral ligament tear. (c-e) Arthroscopic images show the well-defined cyclops nodule (arrow) protruding from the anteromedial bundle of the ACL (c) before, (d) during, and (e) after debridement. (f) Histomicrograph at low power demonstrates fibroblastic and fibrotendinous areas throughout the central portion of the section, with neovascularity (arrowheads). (Hematoxylin-eosin stain; original magnification, x10.) (g) Histomicrograph at high power demonstrates small foci of hemosiderin (arrow) and blood vessels (arrowheads) within a matrix of fibrotendinous tissue. (Hematoxylin-eosin stain; original magnification, x40.)

 

View larger version (127K): [in this window] [in a new window] [Download PPT slide]   Figure 5f.  Posttrauma cyclops lesion in a 27-year-old woman with a high-grade partial-thickness ACL tear and loss of extension. (a) Sagittal FSE T2-weighted image demonstrates a complete tear of the ACL (arrow), which was later characterized as a high-grade partial-thickness tear at arthroscopy. (b) Coronal FSE T2-weighted image shows a small cyclops nodule (arrow) in the anterior intercondylar notch. Note the lateral femoral condylar bone contusion and associated medial collateral ligament tear. (c-e) Arthroscopic images show the well-defined cyclops nodule (arrow) protruding from the anteromedial bundle of the ACL (c) before, (d) during, and (e) after debridement. (f) Histomicrograph at low power demonstrates fibroblastic and fibrotendinous areas throughout the central portion of the section, with neovascularity (arrowheads). (Hematoxylin-eosin stain; original magnification, x10.) (g) Histomicrograph at high power demonstrates small foci of hemosiderin (arrow) and blood vessels (arrowheads) within a matrix of fibrotendinous tissue. (Hematoxylin-eosin stain; original magnification, x40.)

 

View larger version (139K): [in this window] [in a new window] [Download PPT slide]   Figure 5g.  Posttrauma cyclops lesion in a 27-year-old woman with a high-grade partial-thickness ACL tear and loss of extension. (a) Sagittal FSE T2-weighted image demonstrates a complete tear of the ACL (arrow), which was later characterized as a high-grade partial-thickness tear at arthroscopy. (b) Coronal FSE T2-weighted image shows a small cyclops nodule (arrow) in the anterior intercondylar notch. Note the lateral femoral condylar bone contusion and associated medial collateral ligament tear. (c-e) Arthroscopic images show the well-defined cyclops nodule (arrow) protruding from the anteromedial bundle of the ACL (c) before, (d) during, and (e) after debridement. (f) Histomicrograph at low power demonstrates fibroblastic and fibrotendinous areas throughout the central portion of the section, with neovascularity (arrowheads). (Hematoxylin-eosin stain; original magnification, x10.) (g) Histomicrograph at high power demonstrates small foci of hemosiderin (arrow) and blood vessels (arrowheads) within a matrix of fibrotendinous tissue. (Hematoxylin-eosin stain; original magnification, x40.)

 

View larger version (151K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.  Atypical-appearing cyclops lesion in a 56-year-old man who bumped his knee on a boat ladder 2 months before. Since then, his knee "gives way" and he has had loss of extension. (a) Axial FSE proton-density fat-suppressed image depicts a small irregular nodule (arrow) in the intercondylar notch that is slightly hypointense to skeletal muscle. This was a somewhat different imaging characteristic from that of other lesions and may be due to a higher hemosiderin content. (b) Correlating arthroscopic image shows the cyclops lesion and the sprained ACL.

 

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.  Atypical-appearing cyclops lesion in a 56-year-old man who bumped his knee on a boat ladder 2 months before. Since then, his knee "gives way" and he has had loss of extension. (a) Axial FSE proton-density fat-suppressed image depicts a small irregular nodule (arrow) in the intercondylar notch that is slightly hypointense to skeletal muscle. This was a somewhat different imaging characteristic from that of other lesions and may be due to a higher hemosiderin content. (b) Correlating arthroscopic image shows the cyclops lesion and the sprained ACL.

 

View larger version (196K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.  Classic cyclops nodule that occurred after ACL reconstruction. (a) Sagittal FSE proton-density image through the knee demonstrates the intact anterior cruciate ligament graft. (b) Sagittal FSE proton-density image obtained slightly lateral to a demonstrates a slightly heterogeneous nodule (arrow) anterior to the graft. (c) Axial FSE proton-density fat-suppressed image again demonstrates the heterogeneous cyclops nodule (arrow) in the anterior intercondylar notch extending from the ACL graft (arrowhead).

 

View larger version (200K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.  Classic cyclops nodule that occurred after ACL reconstruction. (a) Sagittal FSE proton-density image through the knee demonstrates the intact anterior cruciate ligament graft. (b) Sagittal FSE proton-density image obtained slightly lateral to a demonstrates a slightly heterogeneous nodule (arrow) anterior to the graft. (c) Axial FSE proton-density fat-suppressed image again demonstrates the heterogeneous cyclops nodule (arrow) in the anterior intercondylar notch extending from the ACL graft (arrowhead).

 

View larger version (128K): [in this window] [in a new window] [Download PPT slide]   Figure 7c.  Classic cyclops nodule that occurred after ACL reconstruction. (a) Sagittal FSE proton-density image through the knee demonstrates the intact anterior cruciate ligament graft. (b) Sagittal FSE proton-density image obtained slightly lateral to a demonstrates a slightly heterogeneous nodule (arrow) anterior to the graft. (c) Axial FSE proton-density fat-suppressed image again demonstrates the heterogeneous cyclops nodule (arrow) in the anterior intercondylar notch extending from the ACL graft (arrowhead).

 

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