Summary

Patients with Generalised Joint Hypermobility do well after Primary Anterior Cruciate Ligamnet reconstruction

Abstract

Purpose

The aim of this study was to determine the prevalence of General Joint Hypermobility (GJH) in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) using autografts and to assess the impact of the GJH on the revision rate, postoperative knee laxity and patient-reported outcomes.

Methods

This retrospective cohort study included patients who underwent primary single-bundle anterior cruciate ligament reconstruction (ACLR) using various types of autografts — semitendinosus tendon (ST), quadriceps tendon (QT) with or without bone block, bone-patellar tendon-bone (BPTB), or hamsting tendons (HTs) — at our institution between April 2020 and December 2021. To be included, patients were required to have completed a self-reported Beighton score (BS) questionnaire to assess General Joint Hypermobility (GJH). Data on revision ACLR were retrieved from the Swedish National Knee Ligament Registry (SNKLR) and collected up to two years postoperatively or until a revision surgery was registered, within a window of 6 months to 2 years after the primary reconstruction. Knee laxity was measured preoperatively and at the 6-month follow-up using the KT-1000 arthrometer under a 134 N anterior tibial load. Patient-reported outcome measures, specifically the Knee injury and Osteoarthritis Outcome Score (KOOS), were also obtained from SNKLR at baseline (preoperative), as well as at 1 and 2 years postoperatively

Results

During the study period, a total of 1472 patients underwent ACLR. Of these, 676 patients (45.9%) completed the self-reported Beighton score questionnaire, and 522 of these patients (72.2%) met the inclusion criteria.
Among the included patients, 371 (71.1%) had a BS ≤ 4, and 151 patients (28.9%) had a BS > 4. A subgroup of 89 patients (12.5%) had a BS ≥ 7, indicating a high degree of General Joint Hypermobility (high GJH).
The revision rate among patients with GJH was 1.5% (2/151), compared to 3.5% (13/371) among patients without GJH. This difference was not statistically significant (P=0.31). The incidence of contralateral ACL injury requiring reconstruction was 3.4% (5/151) in patients with GJH and 3.5% (13/371) in patients without GJH. There was no statistically significant difference between the groups (P=0.91).
Postoperative side-to-side (STS) knee laxity showed no significant differences between patients with and without GJH, across graft types: semitendinosus tendon (P=0.82), quadriceps tendon (P=0.826), bone-patellar tendon-bone (P=0.901) and hamstring tendons (P=0.82). Furthermore, no significant difference was found between patients with high degree GJH and without GJH received semitendinosus tendon (P=0.46).
Similarly, there were no significant differences in patient-reported outcomes as measured by KOOS at 1 and 2 years postoperatively between patients with and without GJH.

Conclusions

GJH is common among patients with ACL injury. There was no statistic significant difference between patients with and without GJH regarding revision rate, postoperative knee laxity and KOOS.

Level of evidence: level 3, retrospective cohort study.