Generalised joint hypermobility leads to increased odds of sustaining a second ACL injury within 12 months of return to sport after ACL reconstruction

Review written by Dr Teddy Willsey info

Key Points

  1. Generalized joint hypermobility increases the risk for anterior cruciate ligament (ACL) second injury and is associated with inferior patient outcomes following ACL reconstruction.
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BACKGROUND & OBJECTIVE

Second injuries following anterior cruciate ligament reconstruction (ACLR) continue to plague the sports medicine world, with rates being reported as high as 23% (1). Many of these injuries occur within the early return to sport (RTS) time frame, with research indicating a 7-fold reduction in risk for athletes who wait a minimum of nine months (2). Importantly, second injury statistics include ipsilateral and contralateral tears. Persistent underloading and alterations in mechanics place the unaffected knee at nearly the same risk level as the affected knee (3).

Ligamentous laxity and generalized joint hypermobility (GJH) have been proposed as important factors contributing to second injuries. Interestingly, GJH is more common amongst NCAA Division I athletes than the general population (4). GJH can be a double-edged sword for athletes. The increased joint range of motion (ROM) offers a competitive advantage, while the associated joint instability can increase injury risk (5). Fortunately, screening for GJH only takes 3-5 minutes and does not require any equipment. The Beighton scale provides a framework to place individuals on the GJH spectrum.

The authors of this paper sought to investigate the influence of GJH on ACLR outcomes.

Second injuries following anterior cruciate ligament reconstruction continue to plague the sports medicine world, with rates being reported as high as 23%.
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The article serves as an important reminder for clinicians to use the Beighton scale and to educate their patients on its significance.

METHODS

Project ACL is a Swedish registry established in 2014 that focuses on ACL rehabilitation. This paper is the largest prospective study on the influence of GJH on ACLR outcomes. The registry collects ACLR patient data at set time intervals over

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