PREVALENCE OF GENERALIZED LIGAMENT LAXITY IN ADULT INDIAN POPULATION: A CROSS-SECTIONAL STUDY AND REVIEW OF LITERATURE
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i12.49933Keywords:
Generalized ligament laxity, Prevalence study, Beighton’s score, Joint laxityAbstract
Objective: Generalized ligament laxity (GLL) is defined as increased range of motion across multiple joints in an individual. Its prevalence has been reported to be between 5% and 15%. Although there has been implication of increased prevalence in Indian population, there are relatively few studies related to the prevalence of GLL in adult Indian population. There is also a dearth of literature on, which specialty outpatient department (OPD), these patients commonly present to, with their complaints. The objective of this study was to assess the prevalence of GLL in adult Indian population.
Methods: 5400 patients were selected from various OPDs of a tertiary care hospital after informed consent. After stratification for age and sex, Beighton’s score assessment was done.
Results: Using the Beighton’s score of four or more, to assess the prevalence of generalized ligament laxity, a total of 735 (13.61%) participants had GLL in the entire study population of 5400. Significantly higher number of patients were found to have GLL from the sample recruited from orthopedic OPD (p=0.013) as compared to other OPDs. The highest Beighton’s score was 8/9, recorded in a 29-year female in the orthopedic OPD. It was observed that in all OPDs, the mean Beighton’s scores were higher in female than in male participants in each subgroup; also, there was a decline in mean scores with increase in age in all OPDs which can be inferred as a decrease in GLL with age.
Conclusion: This study is the largest Indian study to investigate the prevalence of GLL in the adult population in India. The study found that there was a significant prevalence of GLL in the adult population especially in females compared to males in all ages, though prevalence of GLL reduced with age. This study has implications of prevention of injuries in people with GLL. Although orthopedic surgeons generally primarily manage the people with GLL, they do not have a high index of suspicion toward the same. Identifying these individuals and making a diagnosis regarding the same is problematic but doing so will help these individuals live a pain-free life.
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References
Bird HA. Joint hypermobility in children. Rheumatol (Oxf Engl) 2005;44:703-4. doi: 10.1093/rheumatology/keh639, PMID 15827037
Juul-Kristensen B, Røgind H, Jensen DV, Remvig L. Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatol (Oxf Engl) 2007;46:1835-41. doi: 10.1093/rheumatology/kem290, PMID 18006569
Kobayasi T. Dermal elastic fibres in the inherited hypermobile disorders. J Dermatol Sci 2006;41:175-85. doi: 10.1016/j.jdermsci.2005.10.002, PMID 16326076
Clinch J, Deere K, Sayers A, Palmer S, Riddoch C, Tobias JH, et al. Epidemiology of generalized joint laxity (hypermobility) in fourteen-year-old children from the UK: A population-based evaluation. Arthritis Rheum 2011;63:2819-27. doi: 10.1002/art.30435, PMID 21547894
Junge T, Henriksen P, Hansen S, Østengaard L, Golightly YM, Juul-Kristensen B. Generalised joint hypermobility and knee joint hypermobility: Prevalence, knee joint symptoms and health-related quality of life in a Danish adult population. Int J Rheum Dis 2019;22:288-96. doi: 10.1111/1756-185X.13205, PMID 29076645
Kumar A, Wadhwa S, Acharya P, Seth S, Khokhar S, Singh R, et al. Benign joint hypermobility syndrome: A hospital-based study from northern India. Indian J Rheumatol 2006;1:8-12. doi: 10.1016/S0973- 3698(10)60515-8
Mullick G, Bhakuni DS, Shanmuganandan K, Garg MK, Vasdev V, Kartik S, et al. Clinical profile of benign joint hypermobility syndrome from a tertiary care military hospital in India. Int J Rheum Dis 2013;16:590-4. doi: 10.1111/1756-185x.12024, PMID 24164848
Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc 2002;34:838-44. doi: 10.1097/00005768-200205000-00017, PMID 11984303
Krivickas LS, Feinberg JH. Lower extremity injuries in college athletes: Relation between ligamentous laxity and lower extremity muscle tightness. Arch Phys Med Rehabil 1996;77:1139-43. doi: 10.1016/ s0003-9993(96)90137-9, PMID 8931525
Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973;32:413-8. doi: 10.1136/ard.32.5.413, PMID 4751776
Carter C, Wilkinson J. Persistent joint laxity and congenital dislocation of the hip. J Bone Joint Surg Br 1964;46:40-5. doi: 10.1302/0301-620X.46B1.40, PMID 14126235
Remvig L, Flycht L, Christensen KB, Juul-Kristensen B. Lack of consensus on tests and criteria for generalized joint hypermobility, Ehlers-Danlos syndrome: Hypermobile type and joint hypermobility syndrome. Am J Med Genet A 2014;164A:591-6. doi: 10.1002/ ajmg.a.36402, PMID 24464988
Vallis A, Wray A, Smith T. Inter- and intra-rater reliabilities of the Beighton score compared to the Contompasis score to assess generalised joint hypermobility. Myopain 2015;23:21-7. doi: 10.3109/10582452.2016.1140255.
Murray KJ. Hypermobility disorders in children and adolescents. Best Pract Res Clin Rheumatol 2006;20:329-51. doi: 10.1016/j. berh.2005.12.003, PMID 16546060
Hakim AJ, Cherkas LF, Grahame R, Spector TD, MacGregor AJ. The genetic epidemiology of joint hypermobility: A population study of female twins. Arthritis Rheum 2004;50:2640-4. doi: 10.1002/art.20376, PMID 15334479
Russek LN, Errico DM. Prevalence, injury rate and, symptom frequency in generalized joint laxity and joint hypermobility syndrome in a “healthy” college population. Clin Rheumatol 2016;35:1029-39. doi: 10.1007/s10067-015-2951-9, PMID 25930211
Al-Jarallah K, Shehab D, Al-Jaser MT, Al-Azemi KM, Wais FF, Al-Saleh AM, et al. Prevalence of joint hypermobility in Kuwait. Int J Rheum Dis 2017;20:935-40. doi: 10.1111/1756-185X.12556, PMID 25529052
Grahame R, Jenkins JM. Joint hypermobility-asset or liability? A study of joint mobility in ballet dancers. Ann Rheum Dis 1972;31:109-11. doi: 10.1136/ard.31.2.109, PMID 5016858
Tingle A, Bennett O, Wallis A, Palmer S. The links between generalized joint laxity and the incidence, prevalence and severity of limb injuries related to physical exercise: A systematic literature review. Phys Ther Rev 2018;23:259-72. doi: 10.1080/10833196.2018.1481626
Ramesh R, Von Arx O, Azzopardi T, Schranz PJ. The risk of anterior cruciate ligament rupture with generalised joint laxity. J Bone Joint Surg Br 2005;87:800-3. doi: 10.1302/0301-620X.87B6.15833, PMID 15911662
Rünow A. The dislocating patella. Acta Orthop Scand 1983;54:1-53. doi: 10.3109/17453678309154170
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