The role of generalised joint Laxity in anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

Abstract

Purpose: This systematic review and meta-analysis aims to assess whether patients with generalised joint laxity (GJL) undergoing anterior cruciate ligament reconstruction (ACLR) have a higher risk of graft failure, worse clinical outcomes and greater residual instability compared to non-lax individuals.

Methods: In accordance with the preferred reporting items for systematic reviews and meta-analyses 2020 guidelines and the PICO frameworks, studies relating to PROMs, residual laxity and re-injury rate or graft failure of patients with GJL after primary ACLR were sought for inclusion. The comparison, when available, consisted of patients without GJL undergoing primary ACLR MINORS was used for the methodological assessment.

Results: A total of 13 studies were included. A total of 3905 patients were included, of whom 55% were male and 45% female. The mean age was 27.5 years (range, 23.4-29.7 years). The mean follow-up period was 41.1 months (range, 12-96 months). International Knee Documentation Committee score showed statistically significant results in favour of non-GJL group (mean value 87.7 ± 10.1) compared to GJL group (mean value 85.2 ± 11.6) (MD = -3.27, p = 0.05). Lysholm Knee Score was significantly higher in non-GJL group (mean value 93.5 ± 5.8) compared to GJL group (mean value 88.5 ± 6.3) (MD = -4.05, p = 0.005). The rates of positivity of Lachman test (OR = 2.62, p < 0.0001) and pivot shift test (OR = 2.25, p = 0.0007) were significantly higher in GJL group. The rate of ACL reconstruction failure was 9.2% in GJL group and 6.1% in non-GJL group without statistical significance (OR = 3.15, p = 0.07).

Conclusions: Patients with GJL appear to have increased postoperative residual knee laxity after ACL reconstruction compared with patients without GJL. Clinical outcomes remain heterogeneous, while no statistically significant differences in graft failure rates were identified. Given the heterogeneity of clinical outcomes, future studies should clarify whether the greater residual laxity represents a clinically relevant disadvantage or whether it can be well tolerated without a meaningful impact on patient-reported and functional outcomes.

Level of evidence: Level III.