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Zeng X, Zhong G, Yang T, Xie Z, Ma L, Huang W, Zhang Y. Generalized joint hypermobility subjects without knee hyperextension have greater walking anterior tibial translation and flexion angle than those with knee hyperextension. Gait Posture 2023; 101:166-172. [PMID: 36863091 DOI: 10.1016/j.gaitpost.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/09/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The walking knee kinematic results of generalized joint hypermobility (GJH) subjects were controversial in previous studies. We proposed that this could be related to the knee statuses of GJH subjects with/without knee hyperextension (KH) and assumed that there are significant sagittal knee kinematic differences between GJH subjects with/without KH during gait. RESEARCH QUESTION Do GJH subjects with KH exhibit significantly different kinematic characteristics than those without KH during walking? METHODS 35 GJH subjects without KH, 34 GJH subjects with KH, and 30 healthy controls were recruited in this study. A three-dimensional gait analysis system was used to record and compare the knee kinematics of the participants. RESULTS Significant walking knee kinematics differences were found between GJH subjects with/without KH during walking. GJH subjects without KH had greater flexion angles (4.7-6.0°, 24-53 % gait cycle (GC), p < 0.001; 5.1-6.1°, 65-77 % GC, p = 0.008) and anterior tibial translation (ATT) (3.3-4.1 mm, 0-4 % GC, p = 0.015; 3.8-4.3 mm, 91-100 % GC, p = 0.01) than those with KH. Compared to controls, GJH without KH exhibited increased ATT (4.0-5.7 mm, 0-26 % GC, p < 0.001; 5.1-6.7 mm, 78-100 % GC, p < 0.001), and range of motion of ATT (3.3 mm, p = 0.028) whereas GJH with KH only exhibited increased extension angle (6.9-7.3°, 62-66 % GC, p = 0.015) during walking. SIGNIFICANCE The findings confirmed the hypothesis and suggested that GJH subjects without KH had more walking ATT and flexion angle asymmetries than those with KH. This may raise concerns about the differences in knee health and risk of knee diseases between GJH subjects with/without KH. However, further investigations should be done to explore the exact influence of walking ATT and flexion angle asymmetries in GJH subjects without KH.
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Affiliation(s)
- Xiaolong Zeng
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Medical college, Shantou University, Shantou 515000, Guangdong, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Zhenyan Xie
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; Medical college, Shantou University, Shantou 515000, Guangdong, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Yu Zhang
- School of Medicine, South China University of Technology, Guangzhou 510006, Guangdong, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
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Batty LM, Firth A, Moatshe G, Bryant DM, Heard M, McCormack RG, Rezansoff A, Peterson DC, Bardana D, MacDonald PB, Verdonk PCM, Spalding T, Getgood AMJ, Willits K, Birmingham T, Hewison C, Wanlin S, Firth A, Pinto R, Martindale A, O'Neill L, Jennings M, Daniluk M, Boyer D, Zomar M, Moon K, Pritchett R, Payne K, Fan B, Mohan B, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Howells F, Tough M, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Millan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Declercq G, Vuylsteke K, Van Haver M. Association of Ligamentous Laxity, Male Sex, Chronicity, Meniscal Injury, and Posterior Tibial Slope With a High-Grade Preoperative Pivot Shift: A Post Hoc Analysis of the STABILITY Study. Orthop J Sports Med 2021; 9:23259671211000038. [PMID: 33889648 PMCID: PMC8033400 DOI: 10.1177/23259671211000038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: A spectrum of anterolateral rotatory laxity exists in anterior cruciate
ligament (ACL)–injured knees. Understanding of the factors contributing to a
high-grade pivot shift continues to be refined. Purpose: To investigate factors associated with a high-grade preoperative pivot shift
and to evaluate the relationship between this condition and baseline
patient-reported outcome measures (PROMs). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A post hoc analysis was performed of 618 patients with ACL deficiency deemed
high risk for reinjury. A binary logistic regression model was developed,
with high-grade pivot shift as the dependent variable. Age, sex, Beighton
score, chronicity of the ACL injury, posterior third medial or lateral
meniscal injury, and tibial slope were selected as independent variables.
The importance of knee hyperextension as a component of the Beighton score
was assessed using receiver operator characteristic curves. Baseline PROMs
were compared between patients with and without a high-grade pivot. Results: Six factors were associated with a high-grade pivot shift: Beighton score
(each additional point; odds ratio [OR], 1.17; 95% CI, 1.06-1.30;
P = .002), male sex (OR, 2.30; 95% CI, 1.28-4.13;
P = .005), presence of a posterior third medial (OR,
2.55; 95% CI, 1.11-5.84; P = .03) or lateral (OR, 1.76; 95%
CI, 1.01-3.08; P = .048) meniscal injury, tibial slope
>9° (OR, 2.35; 95% CI, 1.09-5.07; P = .03), and
chronicity >6 months (OR, 1.70; 95% CI, 1.00-2.88; P =
.049). The presence of knee hyperextension improved the diagnostic utility
of the Beighton score as a predictor of a high-grade pivot shift. Tibial
slope <9° was associated with only a high-grade pivot in the presence of
a posterior third medial meniscal injury. Patients with a high-grade pivot
shift had higher baseline 4-Item Pain Intensity Measure scores than did
those without a high-grade pivot shift (mean ± SD, 11 ± 13 vs 8 ± 14;
P = .04); however, there was no difference between
groups in baseline International Knee Documentation Committee, ACL Quality
of Life, Knee injury and Osteoarthritis Outcome Score, or Knee injury and
Osteoarthritis Outcome Score subscale scores. Conclusion: Ligamentous laxity, male sex, posterior third medial or lateral meniscal
injury, increased posterior tibial slope, and chronicity were associated
with a high-grade pivot shift in this population deemed high risk for repeat
ACL injury. The effect of tibial slope may be accentuated by the presence of
meniscal injury, supporting the need for meniscal preservation. Baseline
PROMs were similar between patients with and without a high-grade pivot
shift.
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Affiliation(s)
- Lachlan M Batty
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Firth
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Gilbert Moatshe
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mark Heard
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Robert G McCormack
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alex Rezansoff
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Devin C Peterson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Davide Bardana
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Peter B MacDonald
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Peter C M Verdonk
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Tim Spalding
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alan M J Getgood
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | | | - Kevin Willits
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Trevor Birmingham
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Chris Hewison
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Stacey Wanlin
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Firth
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ryan Pinto
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ashley Martindale
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Lindsey O'Neill
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Morgan Jennings
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Michal Daniluk
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Dory Boyer
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mauri Zomar
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Karyn Moon
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Raely Pritchett
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Krystan Payne
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Brenda Fan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Bindu Mohan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Gregory M Buchko
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Laurie A Hiemstra
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sarah Kerslake
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Jeremy Tynedal
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Greg Stranges
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sheila Mcrae
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - LeeAnne Gullett
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Holly Brown
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alexandra Legary
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alison Longo
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mat Christian
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Celeste Ferguson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Nick Mohtadi
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Rhamona Barber
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Denise Chan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Caitlin Campbell
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alexandra Garven
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Karen Pulsifer
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Michelle Mayer
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Nicole Simunovic
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Duong
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - David Robinson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - David Levy
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Matt Skelly
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Fiona Howells
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Murray Tough
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Pete Thompson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Metcalfe
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Laura Asplin
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alisen Dube
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Louise Clarkson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Jaclyn Brown
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alison Bolsover
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Carolyn Bradshaw
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Larissa Belgrove
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Francis Millan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sylvia Turner
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sarah Verdugo
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Janet Lowe
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Debra Dunne
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Kerri McGowan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Charlie-Marie Suddens
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Geert Declercq
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Kristien Vuylsteke
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mieke Van Haver
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
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Zhong G, Zeng X, Xie Y, Lai J, Wu J, Xu H, Lin C, Li H, Cui C, Ma L, Li L, Huang W, Zhang Y. Prevalence and dynamic characteristics of generalized joint hypermobility in college students. Gait Posture 2021; 84:254-259. [PMID: 33383536 DOI: 10.1016/j.gaitpost.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/03/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Generalized joint hypermobility (GJH) is a common, but often ignored, condition characterized by general joint laxity, which is reported to increase one's risk of anterior cruciate ligament (ACL) injury and osteoarthritis. Nevertheless, it is not clearly learned in the prevalence and dynamic characteristics in college students. RESEARCH QUESTION Is the active motion stability in the six-degree-of-freedom (6DOF) kinematics of the knee joint of people with GJH poorer than that of others? METHODS This is a cross-sectional study. A population of 489 college students was recruited who was divided into two groups: a GJH group (Beighton score ≥ 4, n = 54) and a normal group (Beighton score < 4, n = 435). A paper questionnaire with questions about the participants' demographic characteristics and musculoskeletal disorder symptoms was collected. A three-dimensional gait analysis system was used to collect the participants' knee joint kinematic parameters during treadmill walking. Variables were evaluated using independent t-tests and Wilcoxon signed-rank tests. RESULTS The prevalence of GJH was found to be 11.0 % among college students. Participants with GJH exhibited a greater active range of motions in the anterior/posterior translation than the normal (P = 0.026). Participants with GJH exhibited greater flexion at the end of the terminal stance (P = 0.039) and greater anterior translation of the tibia during almost the whole gait period than the normal group (P＜0.05) during the treadmill gait. A greater external angle was found in GJH group during the periods of middle stance (P = 0.008). SIGNIFICANCE GJH with a prevalence of 11.0 % among college students should be paid attention. Poor active motion stability in anterior/posterior translation may play an important role in the development of knee joint instability, potentially resulting in subsequent ACL deficiency and the development of knee osteoarthritis among people with GJH.
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Affiliation(s)
- Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China; Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Xiaolong Zeng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Yu Xie
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Junya Lai
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Junhan Wu
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Huan Xu
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Chaoying Lin
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Heng Li
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Can Cui
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Liping Li
- Shantou University Medical College, Shantou, 515041, Guangdong, China.
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China.
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Helito CP, Sobrado MF, Giglio PN, Bonadio MB, Pécora JR, Camanho GL, Demange MK. Combined Reconstruction of the Anterolateral Ligament in Patients With Anterior Cruciate Ligament Injury and Ligamentous Hyperlaxity Leads to Better Clinical Stability and a Lower Failure Rate Than Isolated Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:2648-2654. [PMID: 31421960 DOI: 10.1016/j.arthro.2019.03.059] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare functional outcomes, residual instability, and rupture rates in patients with ligamentous hyperlaxity undergoing isolated anterior cruciate ligament (ACL) reconstruction or combined ACL and anterolateral ligament (ALL) reconstruction. METHODS Two groups of patients were evaluated and compared retrospectively. Both groups consisted of patients with ACL injuries and associated ligamentous hyperlaxity, defined based on the modified Beighton scale with a minimum score of 5. Group 1 patients underwent anatomical ACL reconstruction, and group 2 patients underwent anatomical ACL reconstruction combined with ALL reconstruction. Group 1 consisted of historical controls. The presence of associated meniscal injury, subjective International Knee Documentation Committee and Lysholm functional scores, KT-1000 measurements, the presence of a residual pivot-shift, and the graft rupture rate were evaluated. The study was performed at University of São Paulo in Brazil. RESULTS Ninety patients undergoing ACL reconstruction with ligamentous hyperlaxity were evaluated. The mean follow up was 29.6 ± 6.2 months for group 1 and 28.1 ± 4.2 months for group 2 (P = .51). No significant differences were found between the groups regarding Beighton scale, gender, the duration of injury before reconstruction, follow-up time, preoperative instability, or associated meniscal injuries. The mean age was 29.9 ± 8.1 years in group 1 and 27.0 ± 9.1 years in group 2 (P = .017). In the final evaluation, group 2 patients showed better anteroposterior clinical stability as evaluated by KT-1000 arthrometry (P = .02), better rotational stability as evaluated by the pivot-shift test (P = .03) and a lower reconstruction failure rate (21.7% [group 1] vs 3.3% [group 2]; P = .03). Clinical evaluations of postoperative functional scales showed no differences between the 2 groups (P = .27 for International Knee Documentation Committee; P = .41 for Lysholm). CONCLUSIONS Combined ACL and ALL reconstruction in patients with ligamentous hyperlaxity resulted in a lower failure rate and improved knee stability parameters compared to isolated ACL reconstruction. No differences were found in the functional scales. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcel Faraco Sobrado
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Batista Bonadio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Ricardo Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto Luis Camanho
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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