2025 ISAKOS Biennial Congress ePoster
Number of Positive Hypermobile Joints Increases Rate of Second ACL Injuries.
Jakob E Lindskog, MSc, Gothenburg SWEDEN
Bálint Zsidai, MD, Mölnlycke SWEDEN
Axel Sundberg, Msc, Gothenburg SWEDEN
Johan Högberg, PT, MSc, Gothenburg SWEDEN
Rebecca Simonsson, PT, MSc, Västra Frölunda SWEDEN
Behnam Liaghat, PT, PhD, RISPT, Odense DENMARK
Kristian Samuelsson, Prof, MD, PhD, MSc, Mölndal, Västra Götalands län SWEDEN
Roland Thomee, Professor, Rönnäng SWEDEN
Eric Hamrin Senorski, PT, PhD, Assoc. Prof., Västra Frölunda SWEDEN
Institute of neuroscience and physiology, Gothenburg, SWEDEN
FDA Status Not Applicable
Summary
The rate of second ACL injury was increased by the number of positive hypermobile joints on the Beighton Score, the higher level of sport patients returned to, and the use of hamstring tendon autograft compared to bone-patellar tendon-bone for index ACL reconstruction.
ePosters will be available shortly before Congress
Abstract
Background
Generalized joint hypermobility (GJH) is associated with an elevated risk for second anterior cruciate ligament (ACL) injuries. While traditional binary cut-offs for diagnosing GJH are commonly employed, they present limitations that may lead to inaccurate patient classification and risk assessment.
Aim
This study aimed to evaluate the rate of sustaining a second ACL injury in relation to the number of positive joint hypermobility tests on the Beighton Score, the level of sports activity resumed post-reconstruction, and the type of graft used for the primary ACL reconstruction.
Methods
A prospective cohort study was conducted using data from a rehabilitation-specific registry in Gothenburg. The study included patients aged 15 years or older who underwent primary ipsilateral ACL reconstruction with either a hamstring tendon (HT) or bone-patellar tendon-bone (BPTB) autograft. Participants had documented Beighton Scores, engaged in knee-strenuous sports before injury, returned to sport (RTS) following the primary ACL reconstruction, and either experienced a second ACL injury or had at least one year of follow-up. A multivariable Cox proportional hazard regression model was utilized to estimate the hazard ratio (HR) for a second ACL injury, considering the number of positive joint hypermobility tests on the Beighton Score, the Tegner Activity Scale (Tegner) score at RTS, and the graft choice for the primary ACL reconstruction. Starting point was time of RTS, and end point time of data extraction or time of second ACL injury.
Results
The study included 762 patients, with a mean age of 23.8 ± 7.9 years, of whom 50.9% were female. Eighty-five patients (11.1%) sustained a second ACL injury, with 45 cases (56.5%) being graft ruptures. The HR of a second ACL injury increased by 1.15 times for each positive joint hypermobility test on the Beighton Score (95% confidence interval [CI]: 1.06-1.25, p<0.001), by 1.19 times for each step higher on the Tegner at RTS (95% CI: 1.01-1.40, p=0.038), and by 2.01 times when the HT autograft was used for ACL reconstruction compared to the BPTB autograft (95% CI: 1.06-3.80, p=0.033). The median follow-up period after RTS was 3.9 years (interquartile range: 2.8 years).
Conclusion
The rate of a second ACL injury was significantly associated with an increasing number of positive hypermobile joints on the Beighton Score, higher levels of sport resumed post-reconstruction, and the use of HT autograft over BPTB for ACL reconstruction. These findings suggest that clinicians should not exclusively rely on binary GJH classifications but should also consider the sheer number of hypermobile joints when assessing the risk of subsequent ACL injuries after RTS.