Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: A systematic review

David Sundemo*, Eric Hamrin Senorski, Louise Karlsson, Alexandra Horvath, Birgit Juul-Kristensen, Jon Karlsson, Olufemi R. Ayeni, Kristian Samuelsson

*Corresponding author for this work

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Abstract

Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.

Original languageEnglish
Article numbere000620
JournalBMJ Open Sport and Exercise Medicine
Volume5
Issue number1
Number of pages14
ISSN2055-7647
DOIs
Publication statusPublished - 10. Nov 2019

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Joint Instability
Autografts
Knee
Patellar Ligament
PubMed
MEDLINE
Libraries

Keywords

  • anterior cruciate ligament injury
  • anterior cruciate ligament reconstruction
  • generalised joint hypermobility
  • generalized joint hypermobility
  • hyperextension
  • laxity

Cite this

Sundemo, David ; Hamrin Senorski, Eric ; Karlsson, Louise ; Horvath, Alexandra ; Juul-Kristensen, Birgit ; Karlsson, Jon ; Ayeni, Olufemi R. ; Samuelsson, Kristian. / Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction : A systematic review. In: BMJ Open Sport and Exercise Medicine. 2019 ; Vol. 5, No. 1.
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title = "Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: A systematic review",
abstract = "Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.",
keywords = "anterior cruciate ligament injury, anterior cruciate ligament reconstruction, generalised joint hypermobility, generalized joint hypermobility, hyperextension, laxity",
author = "David Sundemo and {Hamrin Senorski}, Eric and Louise Karlsson and Alexandra Horvath and Birgit Juul-Kristensen and Jon Karlsson and Ayeni, {Olufemi R.} and Kristian Samuelsson",
year = "2019",
month = "11",
day = "10",
doi = "10.1136/bmjsem-2019-000620",
language = "English",
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Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction : A systematic review. / Sundemo, David; Hamrin Senorski, Eric; Karlsson, Louise; Horvath, Alexandra; Juul-Kristensen, Birgit; Karlsson, Jon; Ayeni, Olufemi R.; Samuelsson, Kristian.

In: BMJ Open Sport and Exercise Medicine, Vol. 5, No. 1, e000620, 10.11.2019.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction

T2 - A systematic review

AU - Sundemo, David

AU - Hamrin Senorski, Eric

AU - Karlsson, Louise

AU - Horvath, Alexandra

AU - Juul-Kristensen, Birgit

AU - Karlsson, Jon

AU - Ayeni, Olufemi R.

AU - Samuelsson, Kristian

PY - 2019/11/10

Y1 - 2019/11/10

N2 - Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.

AB - Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.

KW - anterior cruciate ligament injury

KW - anterior cruciate ligament reconstruction

KW - generalised joint hypermobility

KW - generalized joint hypermobility

KW - hyperextension

KW - laxity

U2 - 10.1136/bmjsem-2019-000620

DO - 10.1136/bmjsem-2019-000620

M3 - Review

AN - SCOPUS:85074975907

VL - 5

JO - BMJ Open Sport & Exercise Medicine

JF - BMJ Open Sport & Exercise Medicine

SN - 2055-7647

IS - 1

M1 - e000620

ER -