Generalized Hypermobility, Knee Hyperextension, and Outcomes After Anterior Cruciate Ligament Reconstruction: Prospective, Case-Control Study With Mean 6 Years Follow-up

Christopher M Larson; Asheesh Bedi; Mark E Dietrich; Jennifer C Swaringen; Corey A Wulf; David M Rowley; M Russell Giveans

doi:10.1016/j.arthro.2017.04.012

Generalized Hypermobility, Knee Hyperextension, and Outcomes After Anterior Cruciate Ligament Reconstruction: Prospective, Case-Control Study With Mean 6 Years Follow-up

Arthroscopy. 2017 Oct;33(10):1852-1858. doi: 10.1016/j.arthro.2017.04.012. Epub 2017 Jun 7.

Authors

Christopher M Larson¹, Asheesh Bedi², Mark E Dietrich³, Jennifer C Swaringen³, Corey A Wulf⁴, David M Rowley³, M Russell Giveans⁴

Affiliations

¹ Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A.; Fairview/MOSMI Orthopedic Fellowship Program, Minneapolis, Minnesota, U.S.A.. Electronic address: chrislarson@tcomn.com.
² Department of Orthopedics, University of Michigan MedSport, Ann Arbor, Michigan, U.S.A.
³ Fairview/MOSMI Orthopedic Fellowship Program, Minneapolis, Minnesota, U.S.A.
⁴ Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A.; Fairview/MOSMI Orthopedic Fellowship Program, Minneapolis, Minnesota, U.S.A.

PMID: 28599980
DOI: 10.1016/j.arthro.2017.04.012

Abstract

Purpose: To determine whether generalized hypermobility and contralateral knee hyperextension affect failure rates and patient-related outcomes after anterior cruciate ligament reconstruction (ACLR).

Methods: A total of 226 consecutive patients presenting with acute ACL tears were prospectively evaluated for generalized hypermobility by a modified Beighton criteria. Minimum 2-year follow-up was achieved for 183 knees (81%). Patients underwent ACLR with either bone-patellar-tendon (BPTB) autograft (n = 46), quadrupled hamstring (HT) autograft (n = 85), or allograft tissue (n = 52). KT-1000 measurements, International Knee Documentation Committee (IKDC), Cincinnati, and Lysholm scores were obtained.

Results: Forty-one of 183 consecutive patients were categorized as hypermobile. At mean 6 years' follow-up (range 2-12.5 years), IKDC (P = .003), Cincinnati (P = .001), and Lysholm scores (P < .001) were significantly better in the Non-Hypermobile group for patients with an intact graft. The failure rate was higher in the Hypermobile group (10 knees, 24.4% failure rate) compared with the Nonhypermobile group (11 knees, 7.7% failure rate) (P = .006). The overall ACL injury rate (ACL graft injury, excessive graft laxity, plus contralateral ACL tear) was higher in the Hypermobile group (34.1%) compared with the Nonhypermobile group (12.0%) (P = .002). Heel height >5 cm (P = .009) and fifth metacarpophalangeal (MCP) extension >90° (P = .006) were independently predictive of failure for the entire study population.

Conclusions: Graft failure rates were higher and inferior subjective outcomes were observed after ACLR in patients with generalized hypermobility. Heel height and fifth MCP hyperextension were most predictive of ACL injury/reinjury and poorer outcome scores. Nearly one-third of hypermobile patients sustained a contralateral ACL tear, ipsilateral graft failure, or had excessive graft laxity.

Level of evidence: Level III, case control study.

MeSH terms

Adolescent
Adult
Anterior Cruciate Ligament Injuries / surgery
Anterior Cruciate Ligament Reconstruction*
Bone-Patellar Tendon-Bone Grafting
Case-Control Studies
Child
Female
Follow-Up Studies
Hamstring Muscles / transplantation
Humans
Joint Instability / physiopathology*
Knee Joint / physiopathology*
Male
Middle Aged
Patient Outcome Assessment*
Prospective Studies
Range of Motion, Articular / physiology*
Recurrence
Young Adult