Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction

Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4173-4180. doi: 10.1007/s00167-022-07008-0. Epub 2022 Jun 8.


Purpose: The purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction.

Methods: Data was extracted from a regional rehabilitation-specific registry containing information on patients with ACL injury. Patients between the ages of 16-50 years previously undergoing ACL reconstruction with available 1 year follow-up data were eligible for inclusion. Generalized joint hypermobility was assessed using the Beighton score (BS). Patients were examined one year postoperatively in terms of return to sport, patient-reported outcome, hop tests, muscular strength and the occurrence of reinjury. For purpose of analysis, patients were allocated into two groups, depending on the existence of GJH. The KOOS subscale of sports and recreation was considered the primary outcome. Analyses were performed both dichotomously and by using adjusted logistic regression, to consider potential confounders.

Results: A total of 356 patients (41% males) were included, of which 76 (24% male) were categorized as having GJH. Patients with GJH had an inferior limb symmetry index preoperatively in terms of knee extension (mean 81.6 [SD 16.4] vs. 91.4 [SD 15.9], p = 0.02) and flexion strength (mean 91.9 vs. 99.1, p = 0.047) compared to patients without GJH. There was no difference between the groups in terms of the primary outcome, nor in any of the other postoperative outcomes. Nine patients (11.8%) in the group with GJH suffered ACL re-injury, compared with 13 patients (4.6%) in the control group (n.s.).

Conclusion: One year after ACL reconstruction the existence of GJH did not affect postoperative patient satisfaction, strength or functional outcome. No conclusive statements can be made regarding the influence of GJH on the risk of ACL re-injury in this particular study.

Level of evidence: Level II.

Keywords: Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Generalized joint hypermobility; Generalized joint laxity; Knee surgery; Sports medicine.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries* / complications
  • Anterior Cruciate Ligament Injuries* / surgery
  • Anterior Cruciate Ligament Reconstruction*
  • Female
  • Humans
  • Joint Instability* / surgery
  • Knee Joint / surgery
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Reinjuries*
  • Young Adult