ReviewBMJ open sport & exercise medicine2019
Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review.
Review in BMJ open sport & exercise medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 103 citations in OpenAlex.
- Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury: A Systematic Review with Meta-Analysis.Sports medicine (Auckland, N.Z.) · 2021Pooled it
- Joint hypermobility in athletes is associated with shoulder injuries: a systematic review and meta-analysis.BMC musculoskeletal disorders · 2021Pooled it
- A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19.Scientific reports · 2021Pooled it
- Differences in the collagen of semitendinosus tendon in patients with and without general joint laxity.Bone & joint research · 2026Article
- Generalized joint hypermobility and neck pain: Prevalence and functional correlates from a community-based sample.Clinical biomechanics (Bristol, Avon) · 2026Article
- What does a failure in anterior cruciate ligament reconstruction really mean? An integrative view.Knee surgery & related research · 2026Review
- An Analysis of Characteristics Associated With Bilateral Versus Unilateral Anterior Cruciate Ligament Injuries: A National Database Analysis.Orthopaedic journal of sports medicine · 2026Article
- Increased Hazard Ratio of a Second ACL Injury After Return to Sport for Each Positive Hypermobility Test on the Beighton Score: A Registry Study.Sports medicine - open · 2026Article
- Generalised joint hypermobility and excess knee hyperextension are associated with an increased risk for second ACL injury, but not primary ACL injury, in female football players: A 5-year follow-up.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Outcomes and experiences of patients with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders undergoing surgical interventions: a scoping review.Rheumatology international · 2026Article
- Age is not a primary risk factor for anterior cruciate ligament injury-A comprehensive review of anterior cruciate ligament injury and reinjury risk factors confounded by young patient age.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Review
- Evaluation of the anterior cruciate ligament-injured high-level athlete: a narrative review.Annals of joint · 2026Review
- Lower Limb Biomechanical Observations in Hypermobile Children: An Exploratory Case-Control Study.International journal of environmental research and public health · 2025Article
- Knee hyperextension is not associated with anterior knee laxity, subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Patient Acceptable Symptom State Thresholds for the Lysholm Knee Scoring Scale in Patients After Anterior Cruciate Ligament Reconstruction.Orthopaedic journal of sports medicine · 2025Article
- Outcomes after Surgical Management of Large Joint Manifestations in Ehlers Danlos Syndrome and Hypermobility Conditions in Sports Medicine: a Systematic Review.Current reviews in musculoskeletal medicine · 2025Review
- Article
- No difference in ACL revision rates between hamstring and patellar tendon autograft in patients with ACL-R and a concurrent meniscal injury irrespective of meniscal treatment.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Predicting ACL Reconstruction Failure with Machine Learning: Development of Machine Learning Prediction Models.Orthopaedic journal of sports medicine · 2025Article
- Anatomic Risk Factors for Initial and Secondary Noncontact Anterior Cruciate Ligament Injury: A Prospective Cohort Study in 880 Female Elite Handball and Soccer Players.The American journal of sports medicine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH.
methodsDatabases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included.
resultsTwenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure.
conclusionsIn men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.