The role of generalised joint Laxity in anterior cruciate ligament reconstruction: A systematic review and meta‐analysis
Knee Surgery Sports Traumatology Arthroscopy · 11 Sept 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Surgeons often wonder whether hyperlax patients need a different graft or added lateral procedure, and this review shows the evidence for worse clinical outcomes is inconsistent and failure rates are not statistically different.
The evidence
This meta-analysis pooled 13 studies (3905 patients) comparing outcomes of ACL reconstruction in patients with generalised joint laxity (GJL) versus without. Patients with GJL had significantly lower IKDC and Lysholm scores and higher rates of positive Lachman and pivot shift tests, but the difference in graft failure rate (9.2% vs 6.1%) was not statistically significant (OR 3.15, p=0.07).
ACL reconstruction failure rate: Odds ratio 3.15 (95% CI 0.92 to 10.8; ratio). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Meta-analysis of observational studiesDesign starting point: 37.4
Raised the score
- Prospectively registered+5.1
- Comprehensive literature search+3.4
Lowered the score
- Pools observational studies−6.8
- No assessment of publication bias across 13 studies−6.8
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisNot met
- Publication bias assessedNot met
- Study exclusions justifiedMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 37.4
- Compared against an accepted alternative
- +1.7
- Prospectively registered
- +5.1
- Pools observational studies
- −6.8
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Excluded studies listed and justified
- +1.7
- No assessment of publication bias across 13 studies
- −6.8
- Final rigour score rounded
- 39 / 100
Study design sets the starting point and a ceiling of 78. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Should surgeons routinely add a lateral extra-articular tenodesis or ALL reconstruction in patients with generalised joint laxity given the nonsignificant failure rate difference?
2.Does the finding of greater residual laxity but not worse failure rates change how you counsel hyperlax patients preoperatively about expected outcomes?
Original publication title
The role of generalised joint Laxity in anterior cruciate ligament reconstruction: A systematic review and meta‐analysis