Criterion-Based Rehabilitation Following Cyclops Lesion Excision After ACL Reconstruction in a Competitive Netball Athlete: A Case Report

Background: Evidence guiding criterion-based rehabilitation following secondary knee procedures, such as cyclops lesion excision, is limited. In the absence of procedure-specific guidance, clinicians may therefore draw on existing rehabilitation frameworks and adapt them to the athlete’s persistent impairments, sporting demands, and individual recovery. Objective: To describe how a criterion-based framework, repeated assessment and graded sport exposure were adapted following cyclops lesion excision after anterior cruciate ligament reconstruction in a competitive netball athlete. Case: A 20-year-old female competitive netball athlete underwent cyclops lesion excision approximately 10–11 months after ACL reconstruction using a hamstring autograft with lateral extra-articular tenodesis. Three weeks after excision, involved-limb isometric quadriceps force was 25 kg compared with 69 kg on the uninvolved side, despite minimal pain and satisfactory basic movement. Intervention: An eight-month rehabilitation programme combined supervised physiotherapy, gym and field sessions with independent training. Strength, functional performance, movement quality, symptoms and psychological readiness informed progression through running, field rehabilitation, team training and graded competition. Outcomes: Involved quadriceps force increased to 65 kg and between-limb asymmetry decreased from approximately 64% to 4%. International Knee Documentation Committee subjective knee scores increased from 77 to 98 and Anterior Cruciate Ligament Return-to-Sport After Injury scores from 61.8 to 94.3 between return-to-field and return-to-sport assessments. Residual hamstring and vertical-hop deficits remained when graded competition exposure commenced. The athlete returned to competitive netball and completed a further two-month injury-prevention programme. Conclusion: This case illustrates individualised application of rehabilitation evidence and transparent reporting of progression despite residual deficits. The observed outcomes do not establish treatment effectiveness or the safety of the clearance decision.