GENERALIZED LIGAMENT LAXITY IN PATIENTS UNDERGOING REVISION ACL RECONSTRUCTION

Abstract

Purpose: This study was performed to assess the incidence of generalized ligament laxity in patients undergoing revision ACL reconstruction.

Methods and Results: Prospective data was collected for 40 patients undergoing revision ACL reconstruction, between 2004 and 2009 under the care of a single orthopaedic consultant including demographic details, graft used during primary and revision ACL reconstruction and causes of graft failure.

Clinical examination was used to assess the ligament laxity using the Beighton score. Laxity is scored on a 0–9 scale. Scores of 4 or above are indicative of generalized ligament laxity. Brighton criteria is used to diagnose Benign Joint Hypermobility Syndrome (BJHS) and use signs and symptoms along with Beighton score.

The most common graft used was a quadruple hamstring in 23 patients (57%). The causes of graft failure were trauma in 22 patients (55%), biological in 17 patients (42%) and infection in 1 patient (2.5%).

The revision ACL graft was patella tendon in 23 patients (57%), allograft tendon was used in 11 patients (28%) and quadruple hamstring was used in 4 patients (10%).

The average Beighton score for these patients was 3 with a range from 0–9. 20 patients (50%) in this group had a Beighton score of 4 or more. Only 6 patients (15%) fulfilled the Brighton criteria for BJHS.

Conclusion: We found that there is a high incidence (50%) of generalized ligament laxity in patients undergoing revision ACL reconstruction. Biological failure is common (42%) in these patients after using autogenous tendons. We recommend the use of allograft for primary ACL reconstruction in patients with generalized ligament laxity.