Generalized Joint Laxity in Orthopaedic Patients

Sacks, Hayley; Prabhakar, Pooja; Wessel, Lauren E.; Hettler, Jessica; Strickland, Sabrina M.; Potter, Hollis G.; Fufa, Duretti T.

doi:10.2106/jbjs.18.00458

Cited by 19 publications

(19 citation statements)

References 84 publications

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“…Patients in the first group (LPD group) were required to have had at least 2 episodes of nontraumatic patellar dislocation, with physical and radiological examinations confirming the diagnoses, to meet the inclusion criteria. Patients with a history of operation or trauma, generalized joint laxity (defined as a Beighton score of ≥4 points), 35 passive hyperextension greater than 10° (bilateral testing), and patellofemoral osteoarthritis were excluded.…”

Section: Methodsmentioning

confidence: 99%

Anatomical Components Associated With Increased Tibial Tuberosity–Trochlear Groove Distance

Cui

Yan

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Increased tibial tuberosity–trochlear groove (TT-TG) distance is an important indicator of medial tibial tubercle transfer in the surgical management of lateral patellar dislocation (LPD). Changes to TT-TG distance are determined by a combination of several anatomical factors. Purpose: To (1) determine the anatomical components related to increased TT-TG distance and (2) quantify the contribution of each to identify the most prominent component. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 80 patients with recurrent LPD and 80 age- and body mass index–matched controls. The 2 groups were compared in TT-TG distance and its related anatomical components: tibial tubercle lateralization (TTL), trochlear groove medialization, femoral anteversion, tibiofemoral rotation (TFR), tibial torsion, and mechanical axis deviation (MAD). The Pearson correlation coefficient ( r) was calculated to evaluate the association between increased TT-TG distance and its anatomical parameters, and factors that met the inclusion criteria of P < .05 and r ≥ 0.30 were analyzed via stepwise multivariable linear regression analysis to predict TT-TG distance. Results: The LPD and control groups differed significantly in TT-TG distance, TTL, TFR, and MAD ( P < .001 for all). Increased TT-TG distance was significantly positively correlated with TTL ( r = 0.376; P < .001), femoral anteversion ( r = 0.166; P = .036), TFR ( r = 0.574; P < .001), and MAD ( r = 0.415; P < .001), and it was signficantly negatively correlated with trochlear groove medialization ( r = −0.178; P = .024). The stepwise multivariable analysis revealed that higher TTL, excessive knee external rotation, and excessive knee valgus were statistically significant predictors of greater TT-TG distance ( P < .001 for all). The standardized estimates that were used for evaluating the predictive values were larger for TFR compared with those for TTL and MAD. Conclusion: TTL, TFR, and MAD were the main independent anatomical components associated with increased TT-TG distance, with the most prominent component being TFR. The association of TT-TG distance to each component analyzed in our study may help guide surgical planning.

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Section: Methodsmentioning

confidence: 99%

Anatomical Components Associated With Increased Tibial Tuberosity–Trochlear Groove Distance

Cui

Yan

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…However, it must be noted that a joint may be hypermobile yet stable, and the differentiating factor between hypermobility and instability is the presence of symptoms (9). When a majority of an individual's synovial joints are capable of excessive motion, the patient is diagnosed with generalized joint hypermobility (GJH) (10), which is a hallmark of hereditary disorders of connective tissue.…”

Section: Definitionsmentioning

confidence: 99%

“…In a cadaveric study, hip capsular laxity caused increased joint rotations, femoral head translations, and abnormal movement of the femoral head, leading to microinstability (2). This excess motion of the femur relative the acetabulum can lead to damage to the labrum, cartilage, and capsular structures over time (10). Additionally, Devitt et al demonstrated that in patients undergoing hip arthroscopy for the treatment of FAIS, the presence of GJH was predictive of hip capsular thickness, with those with GJH having a thinner hip capsule (<10 mm) than those without (64).…”

Section: Natural History and Instability Of Hip Hypermobilitymentioning

confidence: 99%

Hypermobile Disorders and Their Effects on the Hip Joint

et al. 2021

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Hypermobility, or joint hyperlaxity, can result from inherited connective tissue disorders or from micro- or macrotrauma to a joint. The supraphysiologic motion of the hip joint results in capsuloligamentous damage, and these patients have a propensity to develop femoroacetabular impingement syndrome (FAIS) and labral injury. In this review, the recent literature evaluating the definitions, history, incidence, genetics, and histology of hypermobile disorders is investigated. We then review the clinical evaluation, natural history, and resulting instability for patients presenting with a hypermobile hip. Lastly, treatment options and outcomes will be highlighted.

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confidence: 99%

“…In 1973, the Beighton score was identified as an appealing method of diagnosing GJH because it utilized 5 basic clinical tests and had a simple 9-point scoring system. 1,8,27 These early studies suggested that GJH predisposed patients to recurrent dislocation, early arthritis, effusions, ligamentous injury, and premature osteoarthritis. 7 More recently, the anterior cruciate ligament (ACL) literature has brought attention to GJH, which is now a well-recognized risk factor for poor outcomes after ACL reconstruction and has been implicated as a potential risk factor for ACL injury.…”

mentioning

confidence: 99%

Injury Risk in Collegiate Football Players With Generalized Joint Hypermobility: A Prospective Cohort Study Over 2 Years

Nicolay

Hartwell

Bigach

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Generalized joint hypermobility (GJH) has been identified as a risk factor for injury in various athletic patient populations. Purpose: To evaluate GJH as a predisposing risk factor for injury in a population of National Collegiate Athletic Association (NCAA) Division I football players. Study Design: Cohort study; Level of evidence, 2. Methods: The Beighton score was collected for 73 athletes during their preseason physical examinations in 2019. GJH was defined as a Beighton score ≥4. Athlete descriptive characteristics, including age, height, weight, and playing position, were recorded. The cohort was evaluated prospectively for 2 years, and the number of musculoskeletal issues, injuries, treatment episodes, days unavailable, and surgical procedures for each athlete during this period were recorded. These measures were compared between the GJH and no-GJH groups. Results: The mean Beighton score was 1.4 ± 1.5 for the 73 players; 7 players (9.6%) had a Beighton score indicating GJH. During the 2-year evaluation, there were 438 musculoskeletal issues, including 289 injuries. The mean number of treatment episodes per athlete was 77 ± 71 (range, 0-340), and the mean number of days unavailable was 67 ± 92 days (range, 0-432 days). There were 23 athletes who required 25 operations, the most common procedure being arthroscopic shoulder stabilization (n = 6). The number of injuries per athlete was not significantly different between the GJH and no-GJH groups (3.0 ± 2.1 vs 4.1 ± 3.0; P = .13), nor were there any between-group differences in the number of treatments received (74.6 ± 81.9 vs 77.2 ± 71.5; P = .47), days unavailable (79.6 ± 124.5 vs 65.3 ± 89.3; P = .61), or rates of surgery (43% vs 30%; P = .67). Conclusion: A preseason diagnosis of GJH did not place NCAA football players at a greater risk for injury during the 2-year study period. Based on the findings of this study, no specific preparticipation risk counseling or intervention is warranted for football players who are diagnosed with GJH as defined by the Beighton score.

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Generalized Joint Laxity in Orthopaedic Patients

Cited by 19 publications

References 84 publications

Anatomical Components Associated With Increased Tibial Tuberosity–Trochlear Groove Distance

Anatomical Components Associated With Increased Tibial Tuberosity–Trochlear Groove Distance

Hypermobile Disorders and Their Effects on the Hip Joint

Injury Risk in Collegiate Football Players With Generalized Joint Hypermobility: A Prospective Cohort Study Over 2 Years

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