An os subfibulare (OS) is frequently seen in adolescents with chronic lateral instability of the ankle, potentially impairing participation in sport and the quality of life. The aim of this study was to compare the clinical outcomes of the modified Broström-Gould procedure in adolescent patients with chronic lateral instability of the ankle with and without an OS. We retrospectively reviewed adolescent patients who underwent a modified Broström-Gould procedure for chronic instability of the ankle between August 2019 and July 2023. Propensity score matching (1:1) was undertaken based on age, sex, side, BMI, the duration of symptoms, pre-injury Tegner score, and joint hypermobility, yielding 82 matched cases (41 OS and 41 non-OS). Preoperative imaging parameters and intraoperative findings were recorded. Primary outcomes included patient-reported outcome measures (PROMs): a visual analogue scale (VAS) for pain, the Karlsson score, the Tegner score, and the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the incidence of re-sprain, the time to return to sport, satisfaction, and complications. Logistic regression analysis identified risk factors for re-sprain. The mean follow-up was 47.8 months (SD 11.2) in the OS group and 47.9 months (SD 9.6) in the non-OS group (p = 0.949). Both groups had significant improvements in all PROMs, with no differences between the groups for the VAS, Karlsson score, Tegner score, or FAOS. Re-sprain occurred in five in the OS group (12.2%) and 12 in the non-OS group (29.3%) (p = 0.081). Multivariate analysis identified higher pre-injury Tegner score (p = 0.001) and concomitant calcaneofibular ligament injury (p = 0.028) as significant independent risk factors for re-sprain. In adolescent patients with chronic lateral instabilty of the ankle, the presence of an OS does not compromise the outcomes of a modified Broström-Gould procedure. Excision of the OS combined with ligamentous repair provides improvements which are comparable to those of an isolated repair, representing a safe and effective form of surgical treatment. Nonetheless, greater attention should be given to patients with high sporting demands or concomitant calcaneofibular ligament injury, due to their increased risk of re-sprain postoperatively.

BACKGROUND: Hip dysplasia is a common cause of hip-related pain in young adults. Hip dysplasia is frequently overlooked by clinicians, leading to delayed diagnosis and subsequent adverse outcomes, including debilitating pain, functional impairments, and poor quality of life. Diagnosing hip dysplasia is often challenging due to its variable clinical presentation, its overlap with other conditions, and the absence of standard diagnostic criteria. Despite these challenges, an emerging body of research provides valuable insight into the management of hip dysplasia. CLINICAL QUESTION: How can new and existing evidence on hip dysplasia be synthesized to support clinicians in understanding its etiopathogenesis and diagnostic approaches-including both imaging and clinical evaluation-and in improving management strategies to enable timely diagnosis and treatment of this common condition? KEY FINDINGS: Hip dysplasia presents with variable symptoms and commonly coexists with other musculoskeletal conditions. Clinical examinations should include assessment of generalized joint hypermobility, hip range of motion, symptom-reproducing tests, and extra-articular structures. Imaging remains essential but must be interpreted in the clinical context. Evidence for non-surgical management, including exercise and education, is emerging but remains limited. CLINICAL APPLICATION: Clinicians should adopt a comprehensive and structured assessment approach that integrates patient history, physical examination, and imaging findings. Awareness of coexisting conditions and alternative pain sources is critical. Early recognition may facilitate timely referral and appropriate management. In the absence of strong condition-specific evidence, clinicians should combine available research with clinical reasoning and consider outcomes beyond pain, including quality of life, physical function, and participation. J Orthop Sports Phys Ther 2026;56(7):382-398. Epub 9 April 2026. doi:10.2519/jospt.2026.13860.

Dance is a complex physical activity with high biomechanical and artistic demands that cause repetitive stress on the musculoskeletal, neuromuscular, metabolic and cardiorespiratory systems. Dance induces physiological adaptations in children and adults, including bone remodelling, improved muscle strength and neuromuscular control, enhanced balance and flexibility, lower limb morphological adaptations and changes in body composition. However, it is also associated with a high incidence of musculoskeletal injuries, predominantly affecting the lower limbs, owing to overuse mechanisms such as sprains, muscle injuries, fractures, stress fractures and soft tissue damage. Growth periods, cumulative training load, technical constraints (eg, pointe shoes, specific footwear, hard surfaces) and individual factors such as joint hypermobility, low energy availability and low body mass index may increase injury risk, potentially affecting performance and quality of life. Acute injuries during professional performances are often recognised as work-related, whereas those sustained during training or rehearsals and chronic conditions related to prolonged practice lack occupational recognition. Emerging observations suggest that dance therapy may offer benefits for certain chronic musculoskeletal conditions, particularly fibromyalgia, although evidence remains limited. This narrative review synthesises the physiological adaptations to dance, the spectrum of dance-related musculoskeletal injuries, associated risk factors and the available data supporting dance as a non-pharmacological intervention. The findings reported herein should be interpreted in light of several limitations, including the narrative design, heterogeneity across studies, small observational samples, inconsistent definitions, potential publication bias and regional variability in practice conditions.

Generalized joint hypermobility (GJH) has been associated with increased risk of second anterior cruciate ligament (ACL) injury. The clinical diagnosis of GJH relies on a binary threshold of positive joint hypermobility tests, based on age and patient sex, which may overlook the degree of hypermobility. To analyze the association between the number of positive joint hypermobility tests on the Beighton Score and the hazard of second anterior cruciate ligament (ACL) injury in patients who return to sport (RTS) after primary ACL reconstruction, which included secondary, stratified analyses of graft rupture and contralateral ACL injury. Registry study. Data were extracted in January 2026 from an ACL-rehabilitation-specific registry, Project ACL. Included patients were 15-50 years who underwent primary ACL reconstruction with hamstring tendon or bone-patellar tendon-bone autograft, had a documented Beighton Score, participated in knee-strenuous sports before injury, had RTS, reported second ACL injury or had ≥ 1 year follow-up without second ACL injury after RTS. Multivariable Cox proportional hazard regression was used to estimate the cause-specific hazard ratio (HR) of second ACL injury (measured from RTS) based on the Beighton Score, adjusted for age, return to pre-injury physical activity level or higher, graft choice, knee hyperextension (≥ 10° knee extension), and patient sex, accounting for competing risks. The analysis included 935 patients (mean age 23.7 ± 7.8 years, 51.4% female), with median Beighton Score of 2 (interquartile range: 4). The median follow-up time was 54.4 months. The cumulative incidence of second ACL injury after RTS was 13.1%. Specifically, the cumulative incidence for graft rupture was 7.4% and 5.7% for contralateral ACL injury. For the primary outcome, each additional positive joint hypermobility test on the Beighton Score was associated with a significantly increased hazard of second ACL injury (adjusted HR: 1.10 (95% CI 1.003-1.22, p = 0.044). For the secondary outcomes, each additional test was associated with an increased hazard of graft rupture (adjusted HR: 1.15, 95% CI 1.01-1.30, p = 0.031), whereas no statistically significant association was observed for contralateral ACL injury. The HR of second ACL injury (graft rupture or contralateral ACL injury) after RTS in patients who had undergone primary ACL reconstruction increased by 10%, and by 15% for isolated graft rupture, for each positive joint hypermobility test on the Beighton Score, while no association was observed for contralateral ACL injury.

Is Generalized Joint Hypermobility a Risk Factor in the Development of Wrist Ganglion Cysts? A Retrospective Case-Control Study.

The diagnosis and management of hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome (HSD/hEDS) are a healthcare challenge because of the wide array of symptoms, lack of diagnostic biomarkers, and evolving management guidelines. This study aimed to describe patient experiences, disability, and self-perceived success managing HSD/hEDS, with or without comorbid postural orthostatic tachycardia syndrome, mast cell activation syndrome, or hip dysplasia. This anonymous online survey explored symptoms, impact on life/function, healthcare experiences, and symptom management status of individuals in the US aged greater than or equal to 13 years with HSD/hEDS. Frequencies and central tendencies were calculated for multiple-choice items. Free-response items were categorized using WHO domains of disability. Seventy-two survey responses were analyzed. The most frequent symptoms were joint hypermobility, joint pain, and subluxations. Disabilities were reported in all six WHO life domains, with life activities being the most common. Most participants (58%) reported symptoms were not well-managed and were more likely to report financial barriers to care and more health conditions compared with other participants. This sample of individuals with HSD/hEDS experiences complex, multifactorial challenges with disability and symptom management. These challenges may be related to comorbidities and financial barriers. Interdisciplinary care models and targeted rehabilitation approaches may improve participation and outcomes, particularly when combined with strategies to reduce logistical and economic barriers.

Dysautonomia and Joint Hypermobility Reflect a Distinct Subtype in Eosinophilic Esophagitis.

Joint hypermobility is associated with connective tissue disorders, hypermobile Ehlers Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD). Affected patients have high rates of myofascial pain and mast cell dysfunction, both of which have been associated with genito-pelvic pain. To characterize diagnoses among patients with hEDS/HSD with genito-pelvic pain.gate thematic evolution and collaboration patterns, network visualisation and clustering analysis were carried out. Gynecology patients were evaluated with the 5-point Hypermobility Questionnaire (5HQ), and positive patients underwent additional diagnostic testing for hEDS and chart review. Patients also completed Female Sexual Function Index (FSFI), and Female Sexual Distress Scale (F-SDS) scales. Diagnoses and survey responses were analyzed with descriptive statistics. Of the 44 total patients with a diagnosis of hEDS, 44 (100%) had provoked vulvodynia confined to the vestibule (vestibulodynia). Similar patterns were noted in patients with hypermobile features not fully meeting hEDS diagnostic criteria. Of patients with provoked vestibulodynia, 31.6% (25/79) had posterior vestibular allodynia, suggesting hypertonic pelvic floor muscle dysfunction as the only cause of their vestibulodynia, and 68.4% (54/79) had diffuse vestibular pain, suggesting an inflammatory, neuroproliferative, or hormonal etiology. Hypermobile features are common among patients presenting for genito-pelvic pain.

Kyphoscoliotic Ehlers-Danlos syndrome (kEDS, OMIM: #225400) is a rare subtype of Ehlers-Danlos syndrome characterized by joint hypermobility and spinal deformity, with occasional vascular complications. The rarity of vascular phenotypes in kEDS often leads to low clinical suspicion, contributing to delayed diagnosis and poor outcomes. We report a 13-year-old boy who presented with joint laxity, scoliosis, blue sclerae, and pectus excavatum, and who ultimately succumbed to aortic rupture. Initial whole-exome sequencing (WES) and copy number variation (CNV) analysis failed to identify a causative variant, and genes associated with Marfan syndrome were excluded by WES and multiplex ligation-dependent probe amplification (MLPA). Upon re-analysis of the WES data, however, a homozygous deletion spanning exons 15-16 of PLOD1 was detected and subsequently confirmed by quantitative PCR. This case demonstrates that small exon deletions in PLOD1 may not be reliably detected by routine WES/CNV pipelines, leading to diagnostic delay, and underscores the underrecognized vascular risk in kEDS. Clinicians should maintain vigilance for vascular complications in patients with kEDS and consider re-analysis strategies to ensure timely diagnosis and appropriate genetic counseling.

The goal of this study was to determine whether the number of connective tissue features in hypermobility is associated with the level of neurodivergent characteristics and establish whether autonomic reactivity may be an explanatory factor in the relationship between variant connective tissue and neurodivergent characteristics. 99 adult participants were assessed for joint hypermobility syndrome/hypermobile Ehlers-Danlos-Syndrome and filled out screening questionnaires for autism and ADHD. 99% of participants met criteria for generalised joint hypermobility, and 57% for hypermobile Ehlers-Danlos-Syndrome. 47% of participants scored above the screening threshold for autism, and 20% for ADHD. All measures were significantly correlated. Level of autonomic reactivity (as measured by the Body Perception Questionnaire) mediated the relationship between the number of connective tissue features and neurodivergence, even after controlling for anxiety level. This shows that autonomic reactivity has a potential mechanistic role in the established link between variant connective tissue and neurodivergence, opening novel pathways for research and clinical care.

Geleophysic dysplasias (GDs) are uncommon genetically predisposed abnormalities that interfere with skeletal growth and formation. Several GD subtypes have different clinical manifestations. The current report presents the case of a 7‐year‐old Syrian boy with a medical history of repeated bone fractures and noticeable facial characteristics. Initial laboratory examinations revealed normal results, except for low serum phosphate and ferritin levels. The X‐ray images showed no abnormalities. The DEXA scan was like that of a 92.1‐year‐old. Karyotype analysis revealed 46 XY. Genetic testing results showed compound heterozygous mutations in the Latent Transforming Growth Factor Beta Binding Protein 3 (LTBP3) gene and a heterozygous mutation in collagen Type V Alpha 1 (COL5A1), consistent with the patient’s clinical manifestations. The following fractures were treated using a combination of nonsurgical casting and surgical intervention. The LTBP3 gene mutations are associated with GD. However, the COL5A1 gene mutations are assumed to be associated with Ehlers–Danlos syndrome Type 1. However, the patient did not exhibit the typical features of joint hypermobility or skin abnormalities, suggesting that the COL5A1 mutation may have a minor effect on his condition. In conclusion, this case highlights the importance of genetic testing in children with repeated fractures and abnormal physical traits. Although the COL5A1 mutation may have a minor influence, further investigation is needed to understand its long‐term effects. This instance also emphasizes the range of physical characteristics that can occur with GD and Marfan syndrome, even when caused by the same genetic mutations.

Generalized joint hypermobility (GJH) is common in developmental dysplasia of the hip (DDH) and may affect recovery after total hip arthroplasty (THA) for Hartofilakidis type C, but its impact on the trajectory of postoperative functional recovery in this severe subgroup has not been clearly characterized. We retrospectively reviewed patients aged 18-40years who underwent THA for unilateral Hartofilakidis type C DDH (2018-2023). GJH was defined as a Beighton score ≥ 5. All procedures used a direct anterior approach with proximal femoral osteotomy for exposure and selective femoral shortening at the lesser trochanter level when reduction would otherwise impose excessive neurovascular tension or unacceptable residual leg-length discrepancy (LLD). Radiographic parameters and LLD were assessed. Harris Hip Score (HHS) was recorded preoperatively and at 1, 3, 6, and 12months. Longitudinal HHS was analysed using a linear mixed-effects model; effect sizes were quantified by Cohen's d and partial η2. Fifty-eight patients were included (21 GJH, 37 non-GJH). Postoperative LLD was reduced without a between-group difference. Cup position at 6months was similar; femoral offset tended to be higher in GJH (p = 0.057). Femoral shortening distance was smaller in GJH (p < 0.001). Observed HHS was lower in GJH at 1-6months (p < 0.001) but similar at 12months. The linear mixed-effects model (LMM) showed significant time, group, and time × group effects (p < 0.001). Adjusted between-group differences were largest at 1month and progressively diminished, becoming non-significant at 12months. One dislocation occurred in the GJH group; no revisions were required. In young adults with unilateral Hartofilakidis type C DDH, GJH did not compromise 12-month hip function after THA but was associated with a slower early recovery trajectory, with the largest deficit during the first 1-3 postoperative months.

Generalized joint hypermobility (GJH) is prototypical clinical feature of hypermobility spectrum disorders, and emerging studies have found a correlation between GJH and structural spinal changes. This study aims to investigate the preoperative radiographic characteristics and clinical outcomes of patients with GJH and adolescent idiopathic scoliosis (AIS). Patients with AIS were prospectively recruited between July 2023 and August 2024 and divided into GJH (Beighton score ≥ 6) and non-GJH (Beighton score < 6) groups. The GJH group was matched 1:1 with controls based on age (±1 year), sex, main curve magnitude (±5°), curve type of the Lenke classification, triradiate cartilage status, and Risser stage (±1 grade). Baseline characteristics and surgical data were recorded. Preoperative and immediately postoperative radiographic parameters were measured. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was collected preoperatively and at least 1 year postoperatively. Univariate analysis and multivariable linear regression analysis were used to identify factors associated with main curve flexibility, TK, and T1 tilt angle. A total of 136 consecutive patients were included, with 29 patients (21.3%) classified into the GJH group. After mating, the GJH showed greater flexibility of the main curve (60.0% ± 27.7% vs. 45.8% ± 22.1%, p = 0.020) and increased thoracic kyphosis (22.9° ± 11.5° vs. 16.7° ± 11.7°, p = 0.031) compared to the control group. Multivariable linear regression analyses revealed that the GJH was correlated with increased spinal flexibility (β = 14.09, p = 0.015) and larger thoracic kyphosis (β = 6.11, p = 0.043). The GJH group demonstrated a relatively higher risk of surgical complications compared to the non-GJH group (17.2% [5/29] vs. 4.7% [5/107], p = 0.036). However, no significant differences were observed in patient-reported outcome measures (PROMs) between the two groups. In patients with AIS, GJH is associated with increased spinal flexibility and greater thoracic kyphosis and, importantly, a higher risk of surgical complications.

Neurodivergent traits are frequently observed in individuals with chronic pain and/or chronic fatigue (CP/CF), yet the underlying mechanisms remain unclear. This study investigated the proportion of likely autism and attention deficit hyperactivity disorder (ADHD) in patients with CP/CF and examined whether joint hypermobility-a marker of variant connective tissue-mediated this relationship. We conducted a case-control study using an online survey. Eighty-three adults with CP/CF and 91 adults from a non-clinical comparison group completed validated screening measures for autism, ADHD, and joint hypermobility. Odds ratios (ORs) and 95% confidence intervals (CIs) for likely neurodivergence were calculated using binary logistic regression. Mediation analysis tested whether joint hypermobility explained the association between likely neurodivergence and CP/CF. Participants with CP/CF had markedly higher odds of likely autism (adjusted OR 14.3 95% CI [6.5, 31.5]) and likely ADHD (adjusted OR 12.9 95% CI [5.0, 26.7]) than the comparison group. The presence of joint hypermobility significantly mediated the relationship between neurodivergent traits and CP/CF (indirect effect: b=1.6 95% CI [1.2, 2.1]). Our findings reveal a trans-diagnostic pattern of major clinical importance. In patients with CP/CF, routine screening for neurodivergence should be considered to optimise fair access to appropriate support for improved quality of life.

Dual Portal Closure of Periportal Capsulotomy for Hip Arthroscopy.

Prevalence, associated disorders and treatment of joint hypermobility syndrome; A systematic review.

Pediatric generalized hypermobility spectrum disorders (pgHSD), are a group of multisystemic heritable connective tissue disorders frequently under-recognized in pediatric populations. The variable and often vague early symptomatology, coupled with the absence of definitive genetic markers, present significant diagnostic challenges. Early manifestations are commonly misattributed to other conditions, leading to substantial diagnostic delays and prolonged morbidity. The purpose of this study is to provide clarity on the presentation of pgHSD symptoms that may ultimately reduce diagnostic delays. A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Comprehensive searches were performed on studies reporting clinical features of patients aged 0-18 years diagnosed with hypermobile Ehlers-Danlos syndrome (hEDS), pgHSD, and joint hypermobility syndrome (JHS). There were 27 studies that met the inclusion criteria searched 1974 to May 8, 2025. Thematic analysis identified eight recurring symptom clusters that frequently characterize early pgHSD. The most consistently reported features included frequent subluxations or dislocations, chronic musculoskeletal pain, disabling fatigue, orthostatic intolerance, and various gastrointestinal complaints. Notably, impaired neurodevelopmental traits were frequently reported. This scoping review maps age-related symptom/comorbidity clusters reported in pediatric hypermobility spectrum disorders, with the aim of informing earlier clinical recognition.

Objectives:Hip microinstability is increasingly being accepted and recognized as a cause of hip pain and dysfunction in young, active patients. Part of the slow acceptance and under-recognition of hip microinstability has been difficulty in understanding the hip examination in those with non-arthritic hip pain, as well as the lack of validated diagnostic criteria. As a result, we performed an international multicenter prospective evaluation of patients undergoing hip arthroscopy to identify clinical predictors of hip microinstability.Methods:Several international hip arthroscopists convened to identify clinical features from history, physical examination and imaging that have been, or potentially could be, clues to the diagnosis of hip microinstability. Then, 3 surgeons from 3 sites agreed to evaluate all patients undergoing hip arthroscopy, including all 184 agreed upon variables, as part of their normal work up. A retrospective analysis was conducted on these prospectively evaluated patients who underwent arthroscopic surgery for intra-articular hip pathology between May 2022 and March 2025 across these sites. Comprehensive demographic and clinical data were extracted from medical records, including symptom duration, sport participation, physical examination findings, family history, and imaging metrics. Intraoperative findings were recorded. The diagnosis of hip microinstability was made based on published criteria of surgical findings. Patients with total hip arthroplasty, hip arthritis of Tonnis grade 2 or more, avascular necrosis, rheumatologic arthritis, pigmented villonodular arthritis, Perthes disease or slipped capital femoral epiphysis were excluded, as were patients who underwent extra-articular hip procedures. Bivariate differences in demographics and clinical variables between those with and without HM were analyzed using two-sample t-tests, chi-square tests, and Fisher’s exact tests. Analyses were completed in RStudio using a two-sided level of significance of 0.05.Results:A combined 802 patients (405 female – 50.5%) with an average age of 34.4 (+ 11.4) underwent hip arthroscopy during the study period; 240 (30%) were confirmed to have intraoperative microinstability. These patients were predominantly female (78%). A history of developmental dysplasia of the hip (DDH) was present in 12.6% of instability patients (vs 4% of those without HM). The mean Beighton score was significantly higher in instability patients (2.7) compared with those without HM (1.2), indicating greater generalized joint hypermobility. There was no statistically significant difference in location of hip pain, mechanical symptoms or popping, clicking or sensation of instability between the HM group and those without hip microinstability.On physical examination, hip range of motion was increased in microinstability patients, with higher average hip flexion (117° vs. 108°), seated external rotation (38° vs. 34°), and seated internal rotation (27° vs. 23°) as measured using an electronic goniometer compared to those without instability. Stress tests, such as the hyperextension-external rotation test (p<0.001), the abduction-extension-external rotation test (p<0.001), the prone external rotation test (p=0.021), the prone apprehension-relocation test (p=0.015 for apprehension, but p=0.07 for pain), and the feeling of pain (p= 0.033) or apprehension (p=0.001) with the axial distraction test were also positive in patients with microinstability statistically more often than in non-instability patients.Imaging findings revealed a higher prevalence of the Cliff sign in instability patients (34% vs. 23%). Instability patients also demonstrated lower lateral center-edge angles (29.1° vs. 30.7°), decreased anterior center-edge angles (ACEA: 32.0° vs. 35.2°), and increased Tönnis angles (5.3° vs. 3.6°). Notably, 16.8% of patients with hip microinstability had normal femoral anteversion compared to only 2.9% of those without instability.Conclusions:Microinstability was bivariately associated with female sex, a prior dysplasia diagnosis, a higher Beighton score, larger range of motion (flexion, seated and prone ER/IR), smaller LCEA and ACEA, larger Tonnis angle, and Cliff sign. There was no difference when the patients were queried about location of hip pain, presence of mechanical symptoms or symptoms such as popping or clicking, or sensation of instability between those with surgically confirmed hip microinstability and those without instability. This study contributes valuable insights into the clinical presentation of patients with hip microinstability, and may help the clinician identify this entity more confidently and readily.

Rare type I collagen variants in early-onset bicuspid aortic valve disease: Overlap with Ehlers-Danlos syndrome and osteogenesis imperfecta

Musculoskeletal disorders in school-aged children: An overview of systematic reviews.