Outcomes after Surgical Management of Large Joint Manifestations in Ehlers Danlos Syndrome and Hypermobility Conditions in Sports Medicine: a Systematic Review.

Purpose of review: Joint hypermobility can increase complications in surgical management of musculoskeletal conditions. The purpose of this review is to 1) summarize clinical outcomes in patients undergoing various Orthopedic sports medicine surgical procedures by joint, and 2) compare outcomes in patients with and without hypermobility.

Recent findings: A total of 38 studies consisting of 144,609 patients and 144,860 joints were included (140,625 shoulders, 2,043 hips, 1,499 knees, 689 ankles, and four elbows). Notable heterogeneity exists within the literature regarding outcomes in hypermobile patients undergoing Orthopedic sports medicine procedures. In general, outcomes for hypermobile patients undergoing procedures of the shoulder, elbow, hip, and knee demonstrated similar or slightly worse outcomes across various patient reported outcomes measures (PROMs) and in terms of recurrent instability or dislocation. There were consistently worse outcomes (e.g. higher rates of post-operative recurrent instability, PROMs) in studies evaluating hypermobile patients undergoing surgery for chronic lateral ankle instability (CLAI) compared to non-hypermobile controls. Patients with joint hypermobility tend to have similar or worse outcomes following Orthopedic sports medicine procedures related to the shoulder, knee, hip, and elbow, and consistently worse outcomes for the ankle. Future studies are encouraged to focus on the effect of hypermobility on elbow and wrist sports pathologies.