Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-11-2019 | KNEE

Generalized joint hypermobility does not influence clinical outcomes following isolated MPFL reconstruction for patellofemoral instability

Authors: Laurie Anne Hiemstra, Sarah Kerslake, Nathalie Kupfer, Mark R. Lafave

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2019

Abstract

Purpose

Generalized joint hypermobility (GJH) has frequently been described as a risk factor for patellofemoral instability; however, only a few primary research studies have demonstrated any evidence of a relationship. The primary purpose of this study was to determine if isolated proximal soft tissue stabilization for patellofemoral instability is as successful in patients with GJH compared those without, as measured by disease-specific quality-of-life (QOL), symptom scores and functional outcomes. The secondary purpose was to determine if clinical and patient-reported outcomes were influenced by patient demographic factors in the presence of joint hypermobility.

Methods

Between 2009 and 2014, data were collected on 174/193 knees (92% follow-up) following an isolated medial patellofemoral ligament reconstruction (MPFL-R). Patients with a Beighton score of 4 or greater were classified as positive for GJH, and any score of 3 or less was classified as negative. Pre- and post-operative Banff Patella Instability Instrument (BPII) scores were compared using a two-sample t test to determine the influence of GJH on QOL. The relationship between the Beighton score, and demographic and clinical factors was explored using correlational analysis. Functional testing including balance and single-leg hop testing was conducted 1 and 2 years post-operatively. Limb symmetry and mean limb-to-limb performance differences were calculated.

Results

In this cohort of isolated MPFL reconstructions, 55.1% had a positive Beighton score. There were seven surgical failures (3.6%). There was no evidence of a relationship between a positive Beighton score and pre-operative BPII scores, post-operative BPII scores or post-operative symptom scores. GJH did not correlate significantly with any post-operative functional testing measures. A positive Beighton score was inversely related to patient age and more prevalent in females.

Conclusions

This study determined that the presence of GJH did not influence disease-specific quality of life, physical symptom score or functional outcomes following MPFL reconstruction.

Level of evidence

III.

Available only for authorised users

al-Rawi Z, Nessan AH (1997) Joint hypermobility in patients with chondromalacia patellae. Br J Rheumatol 36:1324–1327PubMed

Beighton P, Horan F (1969) Orthopaedic aspects of the Ehlers–Danlos syndrome. J Bone Jt Surg Br 51:444–453

Beighton P, Solomon L, Soskolne CL (1973) Articular mobility in an African population. Ann Rheum Dis 32:413–418PubMedPubMedCentral

Bin Abd Razak HR, Bin Ali N, Howe TS (2014) Generalized ligamentous laxity may be a predisposing factor for musculoskeletal injuries. J Sci Med Sport 17:474–478PubMed

Boyle KL, Witt P, Riegger-Krugh C (2003) Intrarater and interrater reliability of the Beighton and Horan Joint Mobility Index. J Athl Train 38:281–285PubMedPubMedCentral

Carter C, Sweetnam R (1958) Familial joint laxity and recurrent dislocation of the patella. J Bone Jt Surg Br 40-B:664–667

Carter C, Wilkinson J (1964) Persistent joint laxity and congenital dislocation of the hip. J Bone Jt Surg Br 46:40–45

Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A (2017) A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. https://doi.org/10.1002/ajmg.c.31539 CrossRefPubMed

Chahal J, Leiter J, McKee MD, Whelan DB (2010) Generalized ligamentous laxity as a predisposing factor for primary traumatic anterior shoulder dislocation. J Shoulder Elbow Surg 19:1238–1242PubMed

10.

Clinch J, Deere K, Sayers A, Palmer S, Riddoch C, Tobias JH et al (2011) Epidemiology of generalized joint laxity (hypermobility) in fourteen-year-old children from the UK: a population-based evaluation. Arthritis Rheum 63:2819–2827PubMedPubMedCentral

11.

Decoster LC, Vailas JC, Lindsay RH, Williams GR (1997) Prevalence and features of joint hypermobility among adolescent athletes. Arch Pediatr Adolesc Med 151:989–992PubMed

12.

Evans AM, Rome K, Peet L (2012) The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study. J Foot Ankle Res 5:1PubMedPubMedCentral

13.

Fisher B, Nyland J, Brand E, Curtin B (2010) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy 26:1384–1394PubMed

14.

Fredericson M, Yoon K (2006) Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehabil 85:234–243PubMed

15.

Grahame R (1971) Joint hypermobility—clinical aspects. Proc R Soc Med 64:692–694PubMedPubMedCentral

16.

Gustavsson A, Neeter C, Thomee P, Silbernagel KG, Augustsson J, Thomee R et al (2006) A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 14:778–788PubMed

17.

Hermanns-Le T, Reginster MA, Pierard-Franchimont C, Delvenne P, Pierard GE, Manicourt D (2012) Dermal ultrastructure in low Beighton score members of 17 families with hypermobile-type Ehlers–Danlos syndrome. J Biomed Biotechnol 2012:878107PubMedPubMedCentral

18.

Hiemstra LA, Kerslake S, Lafave M, Mohtadi NG (2016) Concurrent validation of the Banff Patella Instability Instrument to the Norwich Patellar Instability Score and the Kujala Score in patients with patellofemoral instability. Orthop J Sports Med 4:2325967116646085PubMedPubMedCentral

19.

Hiemstra LA, Kerslake S, Lafave MR, Heard SM, Buchko GM, Mohtadi NG (2013) Initial validity and reliability of the Banff Patella Instability Instrument. Am J Sports Med 41:1629–1635PubMed

20.

Hiemstra LA, Kerslake S, Loewen M, Lafave M (2016) Effect of trochlear dysplasia on outcomes after isolated soft tissue stabilization for patellar instability. Am J Sports Med 44:1515–1523PubMed

21.

Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction. J Bone Jt Surg Br 94-B:1202–1208

22.

Howells NR, Eldridge JD (2012) Medial patellofemoral ligament reconstruction for patellar instability in patients with hypermobility: a case control study. J Bone Jt Surg Br 94:1655–1659

23.

Jessee EF, Owen DS Jr, Sagar KB (1980) The benign hypermobile joint syndrome. Arthritis Rheum 23:1053–1056PubMed

24.

Junge T, Larsen LR, Juul-Kristensen B, Wedderkopp N (2015) The extent and risk of knee injuries in children aged 9–14 with Generalised Joint Hypermobility and knee joint hypermobility—the CHAMPS-study Denmark. BMC Musculoskelet Disord 16:143PubMedPubMedCentral

25.

Juul-Kristensen B, Rogind H, Jensen DV, Remvig L (2007) Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology 46:1835–1841PubMed

26.

Kirk JA, Ansell BM, Bywaters EG (1967) The hypermobility syndrome. Musculoskeletal complaints associated with generalized joint hypermobility. Ann Rheum Dis 26:419–425PubMedPubMedCentral

27.

Lafave MR, Hiemstra L, Kerslake S (2016) Factor analysis and item reduction of the Banff Patella Instability Instrument (BPII): introduction of BPII 2.0. Am J Sports Med 44:2081–2086PubMed

28.

Lafave MR, Hiemstra LA, Kerslake S (2018) Validity, reliability, and responsiveness of the Banff Patellar Instability Instrument (BPII) in a adolescent population. J Pediatr Orthop 38:e629–e633PubMed

29.

Larsson LG, Baum J, Mudholkar GS, Srivastava DK (1993) Hypermobility: prevalence and features in a Swedish population. Br J Rheumatol 32:116–119PubMed

30.

Lippacher S, Dreyhaupt J, Williams SR, Reichel H, Nelitz M (2014) Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med 42:1661–1668PubMed

31.

Naal FD, Hatzung G, Muller A, Impellizzeri F, Leunig M (2014) Validation of a self-reported Beighton score to assess hypermobility in patients with femoroacetabular impingement. Int Orthop 38:2245–2250PubMed

32.

Nicholas JA (1970) Injuries to knee ligaments. Relationship to looseness and tightness in football players. JAMA 212:2236–2239PubMed

33.

Nomura E, Inoue M, Kobayashi S (2006) Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy 22:861–865PubMed

34.

Pacey V, Nicholson LL, Adams RD, Munn J, Munns CF (2010) Generalized joint hypermobility and risk of lower limb joint injury during sport: a systematic review with meta-analysis. Am J Sports Med 38:1487–1497PubMed

35.

Quatman CE, Ford KR, Myer GD, Paterno MV, Hewett TE (2008) The effects of gender and pubertal status on generalized joint laxity in young athletes. J Sci Med Sport 11:257–263PubMed

36.

Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR (2007) Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther 87:337–349PubMed

37.

Remvig L, Jensen DV, Ward RC (2007) Are diagnostic criteria for general joint hypermobility and benign joint hypermobility syndrome based on reproducible and valid tests? A review of the literature. J Rheumatol 34:798–803PubMed

38.

Remvig L, Jensen DV, Ward RC (2007) Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol 34:804–809PubMed

39.

Rikken-Bultman DG, Wellink L, van Dongen PW (1997) Hypermobility in two Dutch school populations. Eur J Obstet Gynecol Reprod Biol 73:189–192PubMed

40.

Ross MD, Langford B, Whelan PJ (2002) Test-retest reliability of 4 single-leg horizontal hop tests. J Strength Cond Res 16:617–622PubMed

41.

Runow A (1983) The dislocating patella. Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. Acta Orthop Scand Suppl 201:1–53PubMed

42.

Russek LN, Errico DM (2016) Prevalence, injury rate and, symptom frequency in generalized joint laxity and joint hypermobility syndrome in a “healthy” college population. Clin Rheumatol 35:1029–1039PubMed

43.

Schneider DK, Grawe B, Magnussen RA, Ceasar A, Parikh SN, Wall EJ et al (2016) Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations: A Systematic Review and Meta-analysis. Am J Sports Med. https://doi.org/10.1177/0363546515624673 CrossRefPubMedPubMedCentral

44.

Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923PubMedPubMedCentral

45.

Smits-Engelsman B, Klerks M, Kirby A (2011) Beighton score: a valid measure for generalized hypermobility in children. J Pediatr 158:119–123PubMed

46.

Stupay KL, Swart E, Shubin Stein BE (2015) Widespread implementation of medial patellofemoral ligament reconstruction for recurrent patellar instability maintains functional outcomes at midterm to long-term follow-up while decreasing complication rates: a systematic review. Arthroscopy. https://doi.org/10.1016/j.arthro.2014.12.029

47.

Valkering KP, Rajeev A, Caplan N, Tuinebreijer WE, Kader DF (2016) An evaluation of the effectiveness of medial patellofemoral ligament reconstruction using an anatomical tunnel site. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-016-4292-x PubMed

48.

van der Giessen LJ, Liekens D, Rutgers KJ, Hartman A, Mulder PG, Oranje AP (2001) Validation of beighton score and prevalence of connective tissue signs in 773 Dutch children. J Rheumatol 28:2726–2730PubMed

49.

Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2013) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324PubMed

50.

Wolf JM, Cameron KL, Owens BD (2011) Impact of joint laxity and hypermobility on the musculoskeletal system. J Am Acad Orthop Surg 19:463–471PubMed

Title: Generalized joint hypermobility does not influence clinical outcomes following isolated MPFL reconstruction for patellofemoral instability
Authors: Laurie Anne Hiemstra
Sarah Kerslake
Nathalie Kupfer
Mark R. Lafave
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05489-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Generalized joint hypermobility does not influence clinical outcomes following isolated MPFL reconstruction for patellofemoral instability

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 11/2019

Tibial slope and medial meniscectomy significantly influence short-term knee laxity following ACL reconstruction

Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction

No correlation between femoral tunnel orientation and clinical outcome at long-term follow-up after non-anatomic anterior cruciate ligament reconstruction

Motivation for sports participation, injury prevention expectations, injury risk perceptions and health problems in youth floorball players

The Blumensaat’s line morphology influences to the femoral tunnel position in anatomical ACL reconstruction

Single-stage revision anterior cruciate ligament reconstruction using bone grafting for posterior or widening tibial tunnels restores stability of the knee and improves clinical outcomes