Anterior cruciate ligament reconstruction in patients with generalized joint laxity.
Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.
Kim
Sung-Jae
SJ
Yonsei University Arthroscopy & Joint Research Institute and Department of Orthopedic Surgery, Yonsei University Health System, Seoul, Korea.
Kumar
Praveen
P
Kim
Sung-Hwan
SH
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D016025:Bone Transplantation / Q000379:methods; D050376:Bone-Patellar Tendon-Bone Grafting / Q000379:methods; D006801:Humans; D007593:Joint Instability / Q000150:complications* / Q000503:physiopathology; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D013710:Tendons / Q000637:transplantation; D016896:Treatment Outcome
Clin Orthop Relat Res. 2010 Apr;468(4):1136-41
19582525
Orthopedics. 2000 Jun;23(6):573-8
10875418
Ann Rheum Dis. 1967 Sep;26(5):419-25
6039590
Am J Sports Med. 2004 Jan-Feb;32(1):159-63
14754739
Ann Rheum Dis. 1973 Sep;32(5):413-8
4751776
Knee Surg Sports Traumatol Arthrosc. 2004 Nov;12(6):534-9
15156305
JAMA. 1970 Jun 29;212(13):2236-9
5467945
J Orthop Sports Phys Ther. 1998 May;27(5):361-7
9580896
J Rheumatol. 1996 Nov;23(11):1963-7
8923376
J Athl Train. 1994 Dec;29(4):343-6
16558298
Arthroscopy. 2009 Feb;25(2):137-44
19171272
Knee Surg Sports Traumatol Arthrosc. 2001 Sep;9(5):313-21
11685365
Rheumatol Int. 2006 Sep;26(11):1050-3
16670858
Br J Sports Med. 2004 Aug;38(4):457-60
15273185
J Rheumatol. 1998 May;25(5):1003-5
9598908
J Bone Joint Surg Br. 1995 Mar;77(2):254-7
7706341
Arthritis Rheum. 1987 Dec;30(12):1426-30
3435571
J Pediatr. 1991 Dec;119(6):944-6
1960613
J Athl Train. 2000 Oct;35(4):403-6
16558652
Acta Paediatr. 2004 Sep;93(9):1202-6
15384884
Rev Rhum Mal Osteoartic. 1957 Jul-Aug;24(7-8):535-9
13518949
Arthritis Rheum. 1980 Sep;23(9):1053-6
7417353
J Athl Train. 1997 Jan;32(1):25-8
16558428
J Bone Joint Surg Am. 1996 Jun;78(6):803-13
8666597
J Athl Train. 1992;27(1):58-62
16558134
J Orthop Sports Phys Ther. 1996 Aug;24(2):91-7
8832472
Am J Sports Med. 2001 Nov-Dec;29(6):722-8
11734484
Rheumatology (Oxford). 2007 Dec;46(12):1835-41
18006569
Int Orthop. 1997;21(2):93-7
9195261
Orthop Clin North Am. 2002 Oct;33(4):637-51
12528906
J Pediatr Orthop. 1991 Nov-Dec;11(6):752-6
1960200
J Athl Train. 2003 Dec;38(4):281-285
14737208
J Sports Med Phys Fitness. 2007 Dec;47(4):446-54
18091686
Microsc Res Tech. 2002 Jul 1;58(1):25-33
12112419
J Rheumatol. 2004 Jan;31(1):173-8
14705238
Rheumatology (Oxford). 2002 May;41(5):554-7
12011380
J Sci Med Sport. 2008 Jun;11(3):257-63
17597005
J Bone Joint Surg Br. 2005 Jun;87(6):800-3
15911662
Magn Reson Imaging. 2007 Jun;25(5):722-6
17540284
Knee Surg Sports Traumatol Arthrosc. 2000;8(1):11-9
10663314
Br J Rheumatol. 1993 Feb;32(2):120-2
8428223
Br J Rheumatol. 1993 Feb;32(2):116-9
8428222
Br J Rheumatol. 1985 Nov;24(4):326-31
4063624
J Rheumatol. 1992 Jan;19(1):115-22
1556672
Am J Sports Med. 2003 Nov-Dec;31(6):831-42
14623646
Am J Sports Med. 2000 Nov-Dec;28(6):783-9
11101098
J Athl Train. 1999 Apr;34(2):99-105
16558566
Am J Sports Med. 2006 Sep;34(9):1512-32
16905673
J Bone Joint Surg Br. 2001 Apr;83(3):348-54
11341418
J Orthop Sports Phys Ther. 1997 Jul;26(1):29-34
9201639
Arthroscopy. 1993;9(2):143-8
8461070
Ann Acad Med Singap. 1999 Mar;28(2):231-6
10497673
Am J Sports Med. 1994 Jan-Feb;22(1):37-43
8129108
Am J Sports Med. 2008 Jun;36(6):1073-80
18326833
Scand J Med Sci Sports. 2000 Oct;10(5):279-85
11001395
J Bone Joint Surg Br. 1964 Feb;46:40-5
14126235
Arthroscopy. 2006 Jul;22(7):797.e1-5
16848060
Br J Rheumatol. 1994 Jan;33(1):56-9
8162460
J Bone Joint Surg Br. 1969 Aug;51(3):444-53
5820785
J Sports Med Phys Fitness. 2006 Mar;46(1):104-10
16596107
J Bone Joint Surg Am. 2002 Sep;84(9):1503-13
12208905
Arthroscopy. 1997 Oct;13(5):656-60
9343660
Rheumatol Int. 2005 May;25(4):260-3
14745505
Arch Orthop Trauma Surg. 2009 Mar;129(3):403-7
18818934
J Bone Joint Surg Am. 2009 Feb;91(2):257-62
19181968
J Bone Joint Surg Am. 2008 Apr;90(4):735-41
18381309
J Am Acad Orthop Surg. 2000 May-Jun;8(3):141-50
10874221
Clin Orthop Relat Res. 2002 Sep;(402):9-20
12218469
Am J Sports Med. 2002 Mar-Apr;30(2):214-20
11912091
J Bone Joint Surg Br. 1992 Jul;74(4):525-7
1624509