Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

Abstract

Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.

Generalized joint hypermobility in siblings with anterior cruciate ligament injuries and matched unrelated healthy siblings

“…Assessing Beighton's criteria individually showed the greatest differences between groups for knee hyperextension and thumb apposition (Table ). Based on these findings, both criteria may represent an increased vulnerability to ACL injury, but knee hyperextension is much more frequently described in ACL‐injured patients (Kim et al, ; Myer et al, ; Ramesh et al, ). Knee hyperextension may also occur independently, not as the result of generalized hypermobility.…”

“…We found that 58% of injured siblings taking part in this current study had generalized hypermobility. Hypermobility has been reported in 42.6% of patients with ACL injuries (Ramesh et al, ) but only in 5–20% of the general population (Kim et al, ) and is a likely risk factor for ACL injury.…”

“…We found that 58% of injured siblings taking part in this current study had generalized hypermobility. Hypermobility has been reported in 42.6% of patients with ACL injuries (Ramesh et al, 2005) but only in 5-20% of the general population (Kim et al, 2010) and is a likely risk factor for ACL injury. Assessing Beighton's criteria individually showed the greatest differences between groups for knee hyperextension and thumb apposition ( Table 2).…”

“…Loudon et al (1996) highlighted the prevalence of hyperextending knees >5 in females with ACL injuries, and as mentioned, Myer et al (2008) showed that knee hyperextension increased the likelihood of ACL injury fivefold. Individuals who demonstrate knee hyperextension >10 have also been shown to demonstrate increased anterior laxity (Kim et al, 2010) and reduced proprioception (Loudon et al, 1996), which further enhances the risk of ACL injury.…”

“…This may make hypermobility a greater risk factor for ACL injury than family history. Although generalized hypermobility is found in 5-20% of the general population (Kim, Kumar, & Kim, 2010), it is strongly associated with ACL injury (Kim, Chang, Kim, Jo, & Oh, 2009;Myer et al, 2008;Ramesh, Von Arx, Azzopardi, & Schranz, 2005) and is reported to be present in 60% of ACL-injured individuals (Vaishya & Hasija, 2013).…”