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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
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Unlock access to our full Course Library and all self-paced Fellowships.
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Lower Extremities MRI Conference
Musculoskeletal Imaging
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Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
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Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Worklist 1
10 topics, 17 min.
Practice Cases
Worklist 2
10 topics, 21 min.
Practice Cases
Worklist 3
10 topics, 28 min.
Practice Cases
Worklist 4
10 topics, 19 min.
Practice Cases
Worklist 5
10 topics, 43 min.
0:00
So we come to this patient,
0:02
27-year-old with prior history of anterior
0:06
cruciate ligament graph reconstruction.
0:09
We see the tibial tunnel here,
0:12
the femoral tunnel, and the graft.
0:14
The graft looks homogeneously dark
0:17
on this T2 weighted sequence.
0:20
It's also homogeneous in caliber.
0:22
However,
0:23
just up post along the anterior margin of the graph,
0:28
we see a heterogeneous focus of signal intensity
0:33
that is propagating within the anterior
0:36
intercondylar notch and is causing some mass
0:39
effect in the infrapatellar fat path.
0:43
That can be very well seen in the axial images
0:48
where the pseudomass
0:50
has intermediate signal intensity
0:53
similar to that of muscle in this sequence,
0:58
On these oblique coronal images through the notch,
1:01
we can confirm that, indeed,
1:04
the graph is completely intact.
1:07
However,
1:08
we are seeing this ball of tissue located in
1:12
the intercondylar notch looking at us.
1:15
So this is a cyclops lesion.
1:18
It's looking at us from the intercondylar notch,
1:21
just one eye,
1:22
Arthroscopists, when they go in,
1:25
in a patient who has this type of injury,
1:28
are going to see a ball of hyperemic soft tissue.
1:32
And that was why it was called a cyclops lesion.
1:37
This complication is typically seen in chronic.
1:42
In the chronic setting,
1:43
it takes months to develop
1:45
and can cause mechanical symptoms,
1:49
particularly limit in the range of motion,
1:52
limit of full extension of the knee,
1:55
because it gets interposed between
1:57
the femur and the tibia.
1:59
So key imaging findings,
2:02
heterogeneous focus of signal intensity,
2:05
propagating from the anterior margin of the graph,
2:08
occupying the anterior intercondylar notch,
2:11
anterior arthrofibrosis, or cyclops lesion.
Wk 3, Case 3 - Review
HIDEInteractive Transcript
0:00
So we come to this patient,
0:02
27-year-old with prior history of anterior
0:06
cruciate ligament graph reconstruction.
0:09
We see the tibial tunnel here,
0:12
the femoral tunnel, and the graft.
0:14
The graft looks homogeneously dark
0:17
on this T2 weighted sequence.
0:20
It's also homogeneous in caliber.
0:22
However,
0:23
just up post along the anterior margin of the graph,
0:28
we see a heterogeneous focus of signal intensity
0:33
that is propagating within the anterior
0:36
intercondylar notch and is causing some mass
0:39
effect in the infrapatellar fat path.
0:43
That can be very well seen in the axial images
0:48
where the pseudomass
0:50
has intermediate signal intensity
0:53
similar to that of muscle in this sequence,
0:58
On these oblique coronal images through the notch,
1:01
we can confirm that, indeed,
1:04
the graph is completely intact.
1:07
However,
1:08
we are seeing this ball of tissue located in
1:12
the intercondylar notch looking at us.
1:15
So this is a cyclops lesion.
1:18
It's looking at us from the intercondylar notch,
1:21
just one eye,
1:22
Arthroscopists, when they go in,
1:25
in a patient who has this type of injury,
1:28
are going to see a ball of hyperemic soft tissue.
1:32
And that was why it was called a cyclops lesion.
1:37
This complication is typically seen in chronic.
1:42
In the chronic setting,
1:43
it takes months to develop
1:45
and can cause mechanical symptoms,
1:49
particularly limit in the range of motion,
1:52
limit of full extension of the knee,
1:55
because it gets interposed between
1:57
the femur and the tibia.
1:59
So key imaging findings,
2:02
heterogeneous focus of signal intensity,
2:05
propagating from the anterior margin of the graph,
2:08
occupying the anterior intercondylar notch,
2:11
anterior arthrofibrosis, or cyclops lesion.
Report
Patient History
27-year-old female complaining of knee pain.
Findings
Menisci:
Medial Meniscus: Slightly truncated inner edge, suggesting previous meniscal trimming. No tear.
Lateral Meniscus: Slightly truncated inner edge, suggesting previous meniscal trimming. No tear.
Ligaments:
Anterior Cruciate Ligament: Status post previous ACL graft repair. A heterogeneous 2.3 x 1.8 x 1.3 cm lesion with mixed T2 hyperintensity and hypointensity is seen anterior to the tibial attachment of the ACL graft, within the intercondylar notch. On T1, the lesion is heterogeneous but predominantly intermediate to low signal. Peripheral susceptibility on the gradient sequence, in keeping with previous post surgical change. Appearances are consistent with a giant cyclops lesion with graft impingement. Tibial and femoral tunnels appear normal.
Posterior Cruciate Ligament: Intact.
Medial Collateral Ligament: Intact.
Lateral Collateral Ligament: Intact.
Poterolateral Corner Structures: Intact.
Posteromedial Corner Structures: Intact.
Extensor Mechanism:
Patellar Tendon: Changes compatible with previous bone-tendon harvesting with diffuse reactive post surgical tendon hypertrophy.
Distal Quadriceps Tendon: Intact.
Medial Patellofemoral Ligament: Intact.
Medial and Lateral Patellar Retinacula: Intact.
Hoffa’s Fat Pad: Unremarkable.
Articulations:
Patellofemoral Compartment: Unremarkable.
Medial Compartment: Mild chondral thinning in the medial compartment.
Lateral Compartment: Unremarkable.
General:
Bones: No tibial or femoral tunnel osteolysis.
Effusion: Small suprapatellar effusion.
Baker’s Cyst: None.
Loose Bodies: None.
Conclusion
1.Giant “Cyclops Lesion” with graft impingement.
2.Status post ACL repair with intact graft.
3.Postsurgical changes of the patellar tendon with moderate reactive tendon hypertrophy.
4.Small joint effusion.
5.No traumatic meniscal tear.
Case Discussion
Faculty
Omer Awan, MD, MPH, CIIP
Associate Professor of Radiology
University of Maryland School of Medicine
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Jenny T Bencardino, MD
Vice-Chair, Academic Affairs Department of Radiology
Montefiore Radiology
Edward Smitaman, MD
Clinical Associate Professor
University of California San Diego
Tags
Musculoskeletal (MSK)
MRI
Knee
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