2025 ISAKOS Biennial Congress Paper
Recovery of Full Hyperextension After ACL Reconstruction is Associated With Better Functional Outcomes but Greater ACL Related Laxity After a Minimum of 24 Months Follow Up
Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Andre Giardino Moreira Da Silva, MD, São Paulo, São Paulo BRAZIL
Riccardo Gomes Gobbi, MD, PhD, São Paulo, SP BRAZIL
José R. Pécora, Prof., São Paulo, SP BRAZIL
University of São Paulo, São Paulo, São Paulo, BRAZIL
FDA Status Cleared
Summary
Patients with knee hyperextension who regained range of motion after ACL reconstruction have worse knee laxity than patients who regained full extension but not hyperextension
Abstract
Introduction
The objective of this study is to evaluate patients submitted to anterior cruciate ligament (ACL) reconstruction with preoperative hyperextension and compare physical examination (KT-1000 and pivot shift) and patient reported outcomes measures of patients who recovered the entire hyperextension with patients who did not.
Methods
Patients aged 18 to 60 years with more than 5 degrees of knee hyperextension submitted to anatomical ACL reconstruction with any graft from June 2013 to June 2021 and at least 24 months of follow-up were evaluated retrospectively. Hamstrings and patellar tendon grafts were fixed around 20 to 30 degrees of flexion and in full extension, respectively. Patients who could recover hyperextension were compared with patients who did not. Pre-operative, intra-operative and post-operative data, including physical examination and patient reported outcomes measures, was evaluated.
Results
A total of 225 patients were evaluated, 48 (21.3%) did not recover hyperextension, and 177 recovered full range of motion. Patients who did not recover hyperextension had a larger graft diameter (8.7 ± 0.7mm (confidence interval 8.502-8.898) vs. 8.3 ± 0.7mm (confidence interval 8.197-8.403); p = 0.018). Regarding the postoperative subjective variables, patients who recovered hyperextension showed improvement on all scales (IKDC, Lysholm, FJS, and GPE) evaluated compared to patients who did not recover the range of motion. Patients who recovered hyperextension also showed more laxity on physical examination, measured by the KT-1000 (1.8 +/- 0.8 vs. 1.1 +/- 1.0; p= 0.0006) and the pivot-shift (Grade 0 – 62.1%;Grade 1 – 37.9% vs. Grade 0 – 79.2%;Grade 1 – 20.8%; p=0.027).
Conclusion
Patients with knee hyperextension who regained range of motion after ACL reconstruction have worse knee laxity than patients who regained full extension but not hyperextension. However, patients who recover full range of motion showed higher scores on subjective function scales, including a greater number of patients who achieved PASS IKDC.