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Updated: Feb 28, 2026
Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Generalized Hypermobility, Knee Hyperextension, and Outcomes After Anterior Cruciate Ligament Reconstruction:
Christopher M Larson1, Asheesh Bedi2, Mark E Dietrich3
1Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A.; Fairview/MOSMI Orthopedic Fellowship Program, Minneapolis, Minnesota, U.S.A..
Purpose:
To determine whether generalized hypermobility and contralateral knee hyperextension affect failure rates and patient-related outcomes after anterior cruciate ligament reconstruction (ACLR).
Methods:
A total of 226 consecutive patients presenting with acute ACL tears were prospectively evaluated for generalized hypermobility by a modified Beighton criteria. Minimum 2-year follow-up was achieved for 183 knees (81%). Patients underwent ACLR with either bone-patellar-tendon (BPTB) autograft (n = 46), quadrupled hamstring (HT) autograft (n = 85), or allograft tissue (n = 52). KT-1000 measurements, International Knee Documentation Committee (IKDC), Cincinnati, and Lysholm scores were obtained.
Results:
Forty-one of 183 consecutive patients were categorized as hypermobile. At mean 6 years' follow-up (range 2-12.5 years), IKDC (P = .003), Cincinnati (P = .001), and Lysholm scores (P < .001) were significantly better in the Non-Hypermobile group for patients with an intact graft. The failure rate was higher in the Hypermobile group (10 knees, 24.4% failure rate) compared with the Nonhypermobile group (11 knees, 7.7% failure rate) (P = .006). The overall ACL injury rate (ACL graft injury, excessive graft laxity, plus contralateral ACL tear) was higher in the Hypermobile group (34.1%) compared with the Nonhypermobile group (12.0%) (P = .002). Heel height >5 cm (P = .009) and fifth metacarpophalangeal (MCP) extension >90° (P = .006) were independently predictive of failure for the entire study population.
Conclusions:
Graft failure rates were higher and inferior subjective outcomes were observed after ACLR in patients with generalized hypermobility. Heel height and fifth MCP hyperextension were most predictive of ACL injury/reinjury and poorer outcome scores. Nearly one-third of hypermobile patients sustained a contralateral ACL tear, ipsilateral graft failure, or had excessive graft laxity.
Level Of Evidence:
Level III, case control study.
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