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Generalized joint hypermobility does not affect clinical outcomes after MPFL reconstruction
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Generalized joint hypermobility did not impact disease-specific quality of life, physical symptom scores or functional outcomes after medial patellofemoral ligament reconstruction, according to recently published results.
“Although generalized joint hypermobility has long been associated with patellofemoral instability, it is unclear how hypermobility affects clinical outcomes after stabilization,” Laurie A. Hiemstra, MD, told Healio.com/Orthopedics. “In this large cohort of patients with an isolated [medial patellofemoral ligament]MPFL reconstruction for recurrent lateral patellofemoral instability, it was demonstrated that the presence of hypermobility did not influence clinical results as measured by quality of life scores.”
From 2009 to 2014, Hiemstra and colleagues collected data on 174 knees after an isolated MPFL reconstruction. Investigators noted that if patients had a Beighton score of 4 or higher, they were categorized as being positive for generalized joint hypermobility. If they had a score of 3 or lower, they were classified as negative for the condition. Preoperative and postoperative Banff Patella Instability Instrument scores were compared and used to determine the impact of generalized joint hypermobility on quality of life. At 1-year and 2-years postoperatively, functional tests which included balance and single-leg hop testing were performed. Investigators calculated limb symmetry and limb-to-limb performance differences.
Of the 174 knees assessed, 55.1% had a positive Beighton score. Investigators reported seven surgical failures. No evidence was found on the association between a positive Beighton score and preoperative and postoperative Banff Patella Instability Instrument scores. There was no significant association between generalized joint hypermobility and postoperative functional testing measures. An inverse association was seen between a positive Beighton score and patient age, and a positive Beighton score was more prevalent in women. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Miho J. Tanaka, MD
In this study, Dr. Hiemstra et al reported on 167 patients undergoing isolated medial patellofemoral ligament (MPFL) reconstruction with hamstring autograft, of which 92 of the patients had a Beighton score of 4 or greater, indicative of generalized joint hypermobility (GJH). In their total study population, Beighton score was found to be significantly correlated with younger age and female sex. At a mean follow up of 25.1 months, the authors found no statistical difference in Bamph Patellar Instability Index (BPII) scores between the GJH and non-GJH groups (66.2 vs 64.8), with no statistical differences when looking specifically at the patients who had knee hyperextension versus not (64.5 vs 66.4). Furthermore, they reported no significant correlation between Beighton score and postoperative functional testing such as single, triple and cross-over hop tests.
The authors have presented one of the largest series comparing outcomes after autograft MPFL reconstruction in patients with and without GJH, showing no significant differences between the two. The findings are encouraging for the use of autograft MPFL reconstruction in patients with GJH and suggest that hyperextension in these patients may not negatively influence outcomes. However, further studies are needed to determine the interaction between GJH and other risk factors such as malalignment, patella alta and trochlear dysplasia, in terms of their potential for combined effects on postoperative outcomes. Larger and longer-term studies can help further elucidate the role of GJH in the development and management of patellar instability.
Department of orthopaedic surgery
The Johns Hopkins Hospital
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Himestra LA, et al. Knee Surg Sports Traumatol Arthrosc. 2019;doi:10.1007/s00167-019-05489-0.
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