The relationship between joint hypermobility and patellar instability: A systematic review

• Published in: Journal of orthopaedics 2024-10, Vol.56, p.40-49
• Main Authors: Heighes, Libbi Anne, Abelleyra Lastoria, Diego Agustín, Beni, Rebecca, Iftikhar, Ahsan, Hing, Caroline Blanca
• Format: Article
• Language: English
• Subjects: Downs syndrome; Ehlers danlos syndrome; Hypermobility; Medial patellofemoral ligament reconstruction; Patellar instability
• ISSN: 0972-978X; 0972-978X
• DOI: 10.1016/j.jor.2024.05.009

Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to determine if joint hypermobility leads to an increased risk of patellar instability, and to evaluate outcomes of treatment for patellar instability in those who exhibit hypermobility. Published and unpublished literature databases were searched to September 7, 2023. Studies comparing prevalence of patellar dislocation/differences in treatment outcomes in patients with and without hypermobility were included. We identified 18 eligible studies (4,391 patients). The evidence was low in quality. A case series on 82 patients found that there was a relationship between generalised joint laxity and patellar instability. This was corroborated by a study comparing 104 patients with patellar dislocation to 110 patients without. Prevalence of generalised joint laxity was six time higher in the former (64.4% vs 10.9%, p  0.5). Another study had 7/31 (22.6%) autografts which failed, compared to 2/16 allografts (12.5%) (p = 0.69). Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. Patients with EDS experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required.