Hypermobility Is a Risk Factor for Nonoperative Treatment Failure in Scapholunate Ligament Injury

Generalized joint hypermobility, defined by the Beighton score, is typically associated with poor outcomes after large ligament injury. However, its impact on scapholunate interosseous ligament (SLIL) injuries remains unknown.

We conducted a retrospective study of adults with isolated SLIL injuries, confirmed using magnetic resonance imaging, presenting to a single academic hand surgeon between 2013 and 2023. Demographics, Beighton scores, pain characteristics, and pain scores after treatment were collected. Hypermobility was defined as a Beighton score of 5 or greater. All patients initially underwent conservative management, with failure defined as persistent pain at 3 months. Patients requiring surgery were followed up for 1 year postoperatively to assess persistent pain. Statistical analysis included χ² testing and multivariable logistic regression.

We included 116 patients, of whom 27% met criteria for hypermobility. Hypermobile patients demonstrated a trend toward higher rates of conservative treatment failure compared with nonhypermobile patients (45% versus 26%, P = 0.05). On multivariate regression, hypermobility was an independent predictor of conservative treatment failure (odds ratio, 4.27; 95% confidence interval, 1.62-11.20). Among surgical patients with adequate follow-up, rates of persistent pain after 1 year were comparable between hypermobile and nonhypermobile patients (56% versus 45%, P = 0.61). The prevalence of hypermobility did not differ significantly between patients with dynamic versus static pain (36% versus 21%, P = 0.09).

Generalized joint hypermobility is associated with increased risk of conservative management failure for SLIL injuries. Screening for hypermobility may help identify patients at higher risk for poor nonoperative outcomes. Further studies are warranted on postoperative outcomes.