My surgeon almost immediately diagnosed me with a cyclops lesion based on my lack of extension.  Has anyone else gotten this diagnosis?

Background: complete tear of right ACL playing basketball 6/17/03.  Went to Brazil for 2 weeks starting 6/21/03.  Did not start formal PT until mid-July.  ACL reconstruction with hamstring tendon autograft 9/10/03.  Did not start formal PT post surgery until 10/2/03.  (HMO only offers a 60 day window of PT per condition per lifetime).  Extension was not zero pre-surgery but seemed better post-surgery.  After 60 day PT window closed in December and I started exercising in a gym my extension started going from about 3 degrees to about 10.  My surgeon is not sure the lesion will show on MRI but agreed to prescribe it.

I've also had this diagnosis--it's a rare complication (less than .5% of patients get it) but even rarer in my case because I didn't have an ACL repair.  I had a lot of soft-tissue work done, then a joint bleed post-op that resulted in terrible bruising and blood pooling in the joint.

It is worthwhile to have an MRI, but not really necessary.  If you have to pay out of pocket for it, I'd say save your $$.  The reason your surgeon diagnosed this right away is that it's one of the more common causes of extension loss and failure to 'thrive' after ACL surgery.  Unfortunately, once that scar tissue is in there underneath the kneecap and around the patellar tendon, it is pretty much impossible to get it out without surgery.  Then you have to do an extremely specialized rehab to keep the scar tissue from forming again.  

There are a couple of types of scar tissue patients: Genetic and situational.  Genetic patients are people who have a probable collagen imbalance and whose immune systems just kick into overdrive and form tons of adhesions.  What I call situational scar tissue patients are people who have normal scarring responses but were immobilized, inappropriately rehabbed, had severe trauma (like a tibial plateau fracture or fractured kneecap), or had a graft harvest from the patellar tendon that left them prone to massive scarring.  Also, some scar tissue specialists have hypothesized that people who have a low pain threshold or inadequate pain control post op will not be able to keep the knee moving freely, and will be more likely to get scar tissue.  I'm not sure how I feel about this, since I got scarring after a surgery that I didn't find particularly painful--I was off meds except at night after 5 days and ditched the crutches then, as well.

Anyway, it's kind of important to figure out which category of scar tissue patients you fall into, because that will help determine treatment.  Unfortunately, the only way to do that is to have surgery again...Catch 22 I'm afraid.  In people like me who form tons of scar tissue, surgery is a bit risky because there is a good chance of the adhesions coming back.  But with your history and ACL repair there's no reason to believe that you're genetically predisposed to forming scar tissue.  Going on that assumption, the recommendation would probably be to do a scope to get the junk out of your knee, then slowly and carefully rehab to keep it from coming back.

The people with scar tissue who have done the best (i.e. returned to full athletic activity) were ones who immediately sought out help from a knee specialist and did a very specialized and tightly controlled post-op protocol.  I didn't do this until my fifth scope, and by then the damage had been done.  You see, in addition to causing pain and lack of extension, the scar tissue underneath the kneecap causes loads of other problems (at least in my case) which include permanent damage to the patellar tendon, scarring down of things like the IT band and lateral retinaculum, patella baja (displaced patella due to scarring) and serious damage to the articular cartilage (arthritis).

HOWEVER, you are very lucky in that you're right in the beginning, your potential scar tissue problems have been identified quickly, and you have the opportunity to not repeat the mistakes a lot of us here (myself included--five scopes and a manipulation in 15 months--d'oh!!)  If you can get this problem taken care of by a specialist and rehab following a very careful protocol, you've got an excellent chance to make a full recovery.

Hope I don't sound too emphatic, but if you do have a cyclops lesion time is not really on your side--after 6-12 months, the chances of full recovery go down.  The longer your knee stays in its altered state, the more likely you wil have some type of degenerative changes.  But I'd encourage you to talk to others who had their adhesions dealt with quickly and correctly--they're back skiing and running again.  So you've got to do your homework, and above all you've got to have faith!  

Definitely have a look around this section and on the web.  There's a great article I posted a link to on arthrofibrosis (scar tissue) that focuses on ACL repairs and the do's and dont's--I'll post a link here as well.  And read up on the surgeries of Janet, myself, Laurie, and a handful of others who have this problem.

Again, I hope I haven't scared you off with these terms and jargon, because you really are in an excellent position to recover fully.  Just keep in mind that this is a rare problem and many doctors will only see a few cases in their lifetimes.  If your doctor hasn't seen this a lot, I'd really find someone who has...my first surgeon was excellent and highly regarded in my city of over 2 million people....but he didn't know how to treat my problem correctly and frankly I suffered because of it.  I don't blame him at all--it's my freakish body, after all, that is overproducing scar tissue.  But I wish I'd known then what I know now.  It would have saved me a lot of grief!  

Heather

PS I used to live in Brazil--really miss it!  But be glad you didn't have to rehab your knee there....