# Greater psychological response and participation in knee‐strenuous activity 8 months after anterior cruciate ligament reconstruction in patients with generalised joint hypermobility who sustained a second anterior cruciate ligament injury: A cross‐sectional registry study

## TL;DR

People with joint hypermobility who had a second ACL injury showed more confidence and higher activity levels 8 months after surgery compared to those without a second injury.

## Contribution

Identifies psychological and activity differences in hypermobile patients with recurrent ACL injuries after surgery.

## Key findings

- Patients with a second ACL injury reported higher confidence in returning to sport at 8 months.
- They participated in more knee-strenuous activities compared to those without a second injury.
- No differences in muscle strength were observed between the groups at any follow-up.

## Abstract

To compare patients with generalised joint hypermobility (GJH) who sustained a second anterior cruciate ligament (ACL) injury with those who did not sustain a second ACL injury, in terms of muscle strength, psychological response and level of knee‐strenuous activity after primary ACL reconstruction. We hypothesised that patients who sustained a second ACL injury would display similar muscle strength symmetry, report similar psychological response and report greater levels of knee‐strenuous activity compared to patients who did not sustain a second ACL injury.

Data from a rehabilitation specific registry were extracted. Patients 15–30 years old with GJH, who sustained a second ACL injury after primary ACL reconstruction were matched 1:2 with patients with GJH who did not sustain a second ACL injury. Outcomes were compared at the 10‐week, 4‐, 8‐ and 12‐month follow‐ups after primary ACL reconstruction. Outcomes comprised limb symmetry index and peak torque relative to body weight for quadriceps and hamstrings muscle groups assessed seated isokinetically with a Biodex. In addition, the questionnaires knee self‐efficacy scale18, ACL‐return to sport after injury scale and Tegner activity scale (Tegner) were analysed. All outcome data were analysed with the independent t‐test, except for the Tegner which was analysed with the Mann–Whitney U‐test.

Thirty‐two patients sustained a second ACL injury and were matched with 64 patients who did not. The mean age at time of ACL reconstruction was 19 ± 3 years, and 58 (60%) were female. There were no differences in muscle strength between groups at any follow‐up. At the 8‐month follow‐up, patients with a second ACL injury reported higher on ACL‐return to sport after Injury (65.6 ± 17.9 vs. 53.5 ± 17.3, p = 0.006), and participated in gknee‐strenuous activity (median Tegner 5.0, interquartile range [IQR]: 3.0 versus 4.0, IQR: 4.0, p = 0.046) compared to patients without a second ACL injury.

Patients with GJH who sustained a second ACL injury reported greater confidence, lower negative emotions, and lesser risk appraisal towards return to sport, and reported greater levels of knee‐strenuous activity at 8 months after primary ACL reconstruction compared to matched patients who did not sustain a second ACL injury. These findings might suggest that patients who report greater psychological readiness to RTS, that is, greater confidence, lower negative emotions and lesser risk appraisal, at 8 months, need more cautious guidance when increasing knee‐strenuous activity.

Level IV, cross‐sectional study.