The objective was to investigate associations between generalized joint hypermobility (GJH) and psychological factors related to return to sport in athletes after anterior cruciate ligament (ACL) reconstruction. In a prospective cohort study using data from a rehabilitation-specific Swedish ACL registry, we included athletes >= 15 years of age following ipsilateral ACL reconstruction with and without GJH using the Beighton score (0-9, 9 = severe hypermobility), with cut points of >= 5/9 for females and >= 4/9 for males. The Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale (10-100, 100 = best) was used to assess athletes' emotions, confidence, and risk appraisal 8-24 months post-surgery. We used linear regressions for continuous ACL-RSI scores and logistic regression to compare high (>= 65) vs. low scores to estimate the associations with GJH and Beighton scores, adjusted for age and sex. Data for 1410 athletes (mean age 27.3 years, 56% women, 22% GJH) were extracted from the registry, with soccer (35.8%) and handball (10.4%) being the most common pre-injury sports. At 8-18 months, ACL-RSI scores were associated with both GJH (range of mean beta coefficients -1.16 to -4.27) and Beighton score (range of mean beta coefficients -0.30 to -0.77). At 8 months, athletes with GJH were less likely to exceed the ACL-RSI threshold (odds ratio 0.71; 95% confidence interval 0.53 to 0.96; p = 0.026), with nonsignificant results at 12-24 months for higher Beighton scores. In conclusion, athletes with GJH appear to exhibit lower ACL-RSI scores after ACL reconstruction, compared with athletes without GJH.
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