{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T15:01:20Z","timestamp":1783436480210,"version":"3.54.6"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to investigate the association between generalised joint hypermobility, knee hyperextension, knee laxity, and static standing alignment with the risk of anterior cruciate ligament (ACL) injury in a cohort of female football players with an ACL\u2010reconstructed (ACLR) knee and in knee\u2010healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively followed 117 female football players with ACLR (age, mean\u2009\u00b1\u2009standard deviation, 20\u2009\u00b1\u20092 years; average 19\u2009\u00b1\u20099 months after ACLR) and 119 knee\u2010healthy players (age, 19\u2009\u00b1\u20093 years) for 5 years. At baseline, all players were assessed for generalised joint hypermobility (Beighton score), knee extension range of motion, knee laxity (KT\u20101000, Lachman and pivot shift tests), and static standing alignment (visual assessment graded as varus, valgus or neutral). Log\u2010binomial regression with risk ratios (RRs) and 95% confidence intervals (CIs) for new ACL injury were calculated. Point biserial and Spearman's rank correlations were used for correlation analysis of baseline anatomical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During the 5\u2010year follow\u2010up, 43 ACLR players sustained a second ACL injury (30 re\u2010ruptures and 13 contralateral ruptures) and 11 knee\u2010healthy players had an index ACL injury. ACLR players with Beighton score\u2009\u22655 (RR, 1.67; 95% CI, 1.04\u20132.70;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035) and knee hyperextension\u2009&gt;5\u00b0 in the non\u2010ACL\u2010reconstructed knee (RR, 1.67; 95% CI, 1.02\u20132.73;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042) had higher risk of a second ACL injury; knee laxity and static standing alignment were not associated with a second ACL injury (n.s.). No significant associations were seen between baseline variables and index ACL injury in knee\u2010healthy players (n.s.). There was moderate correlation between KT\u20101000 and the Lachman test (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.594\u20130.673), and negligible to moderate correlations between other baseline variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Generalised joint hypermobility and knee hyperextension were associated with an increased risk of second ACL injury in female football players with ACLR. Screening for generalised joint hypermobility and knee hyperextension may inform prevention strategies for female football players after ACL injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level I.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70011","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T10:22:43Z","timestamp":1757413363000},"page":"2025-2037","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Generalised joint hypermobility and excess knee hyperextension are associated with an increased risk for second ACL injury, but not primary ACL injury, in female football players: A 5\u2010year follow\u2010up"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3811-7381","authenticated-orcid":false,"given":"Anne","family":"F\u00e4ltstr\u00f6m","sequence":"first","affiliation":[{"name":"Region J\u00f6nk\u00f6ping County, Rehabilitation Centre Ryhov County Hospital J\u00f6nk\u00f6ping Sweden"},{"name":"Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3527-5488","authenticated-orcid":false,"given":"Joanna","family":"Kvist","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy Link\u00f6ping University Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6883-1471","authenticated-orcid":false,"given":"Martin","family":"H\u00e4gglund","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy Link\u00f6ping University Link\u00f6ping 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