Mean Beighton Score Research Articles

Frequency of joint hypermobility using Beighton’s score in patients of fibromyalgia at a tertiary care hospital

Objective: To determine frequency of joint hypermobility in patients of fibromyalgia presenting to our institution. Methodology: This observational cross-sectional analytical study was conducted from June 2021 to May 2022 at Department of Medicine & Allied, Azra Naheed Medical College, Superior University, Lahore, Pakistan. Fibromyalgia was defined according to the 1990 ACR diagnostic Criteria of Fibromyalgia. Localized Joint Hypermobility was defined as <3 score and generalized Joint Hypermobility was defined as >4 score on the Beighton Score Scale. The study included 266 patients with fibromyalgia of both sexes aged between 16 years to 35 years. Joint hypermobility was assessed by using Beighton score. Results: Mean age was 26.5+4.6 years with 178 (66.9%) females. Mean BMI was 23.9+3.9 kg/m2. Mean Beighton score was 1.1+2.4. Generalized Joint Hypermobility was seen in 34 (12.8%) patients, 23 (8.6%) had localized hypermobility whereas 209 (78.6%) had no hypermobile joints. Stratification of outcome was done with regards to age (p=0.683), sex (p=0.238) and BMI (p=0.482). Conclusion: This study showed that generalized joint hypermobility was present approximately in one out of every 10 patients and a quarter of patients had at least one clinically documented hypermobile joint.

Paper 28: Both Hamstring Autograft Combined with Lateral Extra-Articular Tenodesis and Quadriceps Autograft Lead to Lower Graft Re-Tear Rates and Pivot Shift After ACL Reconstruction Compared to Hamstring Autograft Alone

Paper 28: Both Hamstring Autograft Combined with Lateral Extra-Articular Tenodesis and Quadriceps Autograft Lead to Lower Graft Re-Tear Rates and Pivot Shift After ACL Reconstruction Compared to Hamstring Autograft Alone

Injury Risk in Collegiate Football Players With Generalized Joint Hypermobility: A Prospective Cohort Study Over 2 Years.

Generalized joint hypermobility (GJH) has been identified as a risk factor for injury in various athletic patient populations. To evaluate GJH as a predisposing risk factor for injury in a population of National Collegiate Athletic Association (NCAA) Division I football players. Cohort study; Level of evidence, 2. The Beighton score was collected for 73 athletes during their preseason physical examinations in 2019. GJH was defined as a Beighton score ≥4. Athlete descriptive characteristics, including age, height, weight, and playing position, were recorded. The cohort was evaluated prospectively for 2 years, and the number of musculoskeletal issues, injuries, treatment episodes, days unavailable, and surgical procedures for each athlete during this period were recorded. These measures were compared between the GJH and no-GJH groups. The mean Beighton score was 1.4 ± 1.5 for the 73 players; 7 players (9.6%) had a Beighton score indicating GJH. During the 2-year evaluation, there were 438 musculoskeletal issues, including 289 injuries. The mean number of treatment episodes per athlete was 77 ± 71 (range, 0-340), and the mean number of days unavailable was 67 ± 92 days (range, 0-432 days). There were 23 athletes who required 25 operations, the most common procedure being arthroscopic shoulder stabilization (n = 6). The number of injuries per athlete was not significantly different between the GJH and no-GJH groups (3.0 ± 2.1 vs 4.1 ± 3.0; P = .13), nor were there any between-group differences in the number of treatments received (74.6 ± 81.9 vs 77.2 ± 71.5; P = .47), days unavailable (79.6 ± 124.5 vs 65.3 ± 89.3; P = .61), or rates of surgery (43% vs 30%; P = .67). A preseason diagnosis of GJH did not place NCAA football players at a greater risk for injury during the 2-year study period. Based on the findings of this study, no specific preparticipation risk counseling or intervention is warranted for football players who are diagnosed with GJH as defined by the Beighton score.

Assessing Bleeding Symptoms in Pediatric Patients With Generalized Joint Hypermobility.

To assess bleeding symptoms in patients with generalized/benign joint hypermobility (GJH), compare bleeding scores to healthy historical pediatric controls, and determine whether a correlation exists between Beighton scores and bleeding scores. Patients with GJH ages 6-21 years seen by the rheumatology department at Nationwide Children's Hospital in Columbus, Ohio were eligible. Participants/guardians completed the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool, a validated questionnaire defining the presence, severity, and frequency of bleeding symptoms. Scores of ≥3 have been associated with an underlying bleeding disorder in pediatric patients. Eighty-one patients agreed to participate. The median age was 13 years (interquartile range 10-16 years), and the mean Beighton score was 6.3 (range 4-9). Commonly observed bleeding symptoms were oral bleeding (74%), easy bruising (59%), and bleeding with minor wounds (42%). Mean and median bleeding scores were 5.2 and 4, respectively, and were significantly higher than reported bleeding scores in pediatric controls, defined as those without bleeding symptoms or a previously diagnosed bleeding disorder (P < 0.001). Although 75% of patients (95% confidence interval 64-84) had an abnormal bleeding score, only 12.3% were previously assessed by hematology for bleeding symptoms. Among patients with GJH, higher Beighton scores were not associated with higher bleeding scores (Spearman's correlation -0.08). In a cohort of pediatric patients with GJH, three-fourths of participants had abnormal bleeding scores, with the mean bleeding score significantly elevated compared to healthy controls. We propose that screening for bleeding symptoms be integrated into routine care for GJH patients, with referral to hematology for patients with bleeding concerns.

The anterior talofibular ligament ratio was greater in young men with generalized joint laxity than in those without generalized joint laxity.

This study aimed to evaluate the relationship between generalized joint laxity (GJL) and stress ultrasonographic (US) findings of the anterior talofibular ligament (ATFL) of healthy young men. The ATFL lengths of healthy young men were consecutively measured in the stress and nonstress positions. The ATFL ratio was calculated as an indicator of lateral ankle laxity. GJL was evaluated using the Beighton score (BS), and a BS of ≥ 5 was considered GJL. The manual anterior drawer test (ADT) was also performed. The results of stress US and ADT were compared between subjects with and without GJL, and the correlation between GJL and US findings was examined. A total of 13 subjects with GJL and 95 without GJL were included in the study. The mean BSs in the GJL and no-GJL groups were 5.9 ± 0.9 and 1.1 ± 1.3, respectively (p < 0.0001). The GJL group showed a higher grade of ADT than the no-GJL group (p < 0.0001). Significant differences were found in the stress ATFL length (23.6 ± 1.8mm vs. 21.7 ± 1.8mm, p = 0.002) and ATFL ratio (1.15 ± 0.06 vs. 1.07 ± 0.03, p < 0.0001) between the GJL and no-GJL groups. Spearman's correlation coefficients showed a moderate correlation between the BS and ATFL ratio (r = 0.45, p < 0.0001). The present study showed significant differences in the ATFL ratio and stress ATFL length between young men with and without GJL. The BS was moderately correlated with the lateral ankle laxity in this population. Level IV.

Outcomes of Allograft Medial Patellofemoral Ligament Reconstruction in Children and Adolescents with Hypermobility.

IntroductionMedial patellofemoral ligament (MPFL) reconstruction is used to treat patellofemoral instability either in isolation or in combination with other procedures. Use of allograft can preserve native tissue in children and can be advantageous in patients with connective tissue disorders, including ligamentous laxity. There is limited evidence regarding functional outcomes of allograft MPFL reconstruction in children and adolescents. This study aimed to assess the short to mid-term results of allograft MPFL reconstruction in children with hypermobility at a tertiary pediatric orthopedic center.Materials and Methods:We retrospectively reviewed all children and adolescents who had undergone allograft MPFL reconstruction over 4 years. The primary outcome measure was the validated Kujala score for patellofemoral disorders. The secondary outcome measures included complications such as redislocation of the patella needing revision surgery. Patients with hypermobility were quantified using Beighton criteria. Statistical analysis was performed using Graph Pad Prism (V6).ResultsBetween 2012 and 2016, the senior author performed 76 allograft MPFL reconstructions in 57 patients. Nineteen patients had bilateral surgery. The mean age was 14 (7–16) years with a female: male ratio of 3:1. The mean Beighton score was 7. Hypermobility was part of a syndrome in ten patients. The mean follow-up was 3 (1–4) years. Nine patients had trochleoplasty and six patients had tibial tubercle osteotomy, in addition to allograft MPFL reconstruction. These fifteen patients, who had additional procedures, were excluded during the analysis of the outcome measures. The mean Kujala score was 89 (80–100). The overall complication rate was 11% (9/76). These included two patella fractures and seven (9%) patients with recurrent instability needing revision surgery. There was no significant difference in complication rates between syndromic and nonsyndromic patients (P = 0.9).ConclusionOur study shows excellent short to mid-term functional outcomes of allograft MPFL reconstruction in children and adolescents with hypermobility.

Generalized Joint Laxity Is Associated With Dynamic Hip Ultrasonography Measures in Female Athlete Patients Who Are Not Hypermobile.

To investigate ultrasound (US) femoroacetabular translation measurements in female athlete patients. A prospective cross-sectional study was conducted in female athlete patients <50 years. Demographic data, Beighton score/hypermobility status, and sport participation were collected. Hip dysplasia was determined using radiographic measurements (lateral center edge angle, anterior center edge angle, Tönnis angle); femoral version angles were measured with CT or MR. Femoroacetabular translation US measures included neutral (N), neutral flexed (NF), extension external rotation/apprehension (EER) positions. Maximal difference (delta) between US measures was calculated. 206/349 female hips were analyzed (median age 21.2 years [range, 12-49.5]). The primary sport group was performing arts (45%, 92/206). Mean Beighton score was 5.2 (SD, 2.5) with 61% (129/206) of hips exhibiting hypermobility (Beighton score ≥5). For each additional unit of Beighton score, N US measurement increased by 0.7 mm (β=0.7; 95% confidence interval [CI]=0.22-1.25; P < .001), NF by 1 mm ( = 0.9; 95% CI=0.3-1.43; P=.002) and EER by 0.8 mm ( = 0.8; 95% CI=0.27-1.37; P < .001) when adjusting for age and dysplasia status. A positive correlation was detected between NF (r=0.19; 95% CI=0.05-0.33; P=.007) and EER (r=0.19; 95% CI=0.05-0.32; P=.01) with Tönnis angle and a negative correlation between the delta and femoral version (r=-0.20; 95% CI=-0.35 to 0.03; P=.02). No difference in US measures was detected across sport groups (N [P=.24], NF [P=.51], EER [P=.20], delta [P=.07]). Beighton score was independently associated with dynamic US measures in female athlete patients who are not hypermobile when controlling for other factors.

Generalized Joint Hypermobility and Injuries: A Prospective Cohort Study of 185 Pre-Professional Contemporary Dancers.

Generalized joint hypermobility (GJH) has been mentioned as one of the factors associated with dance injuries, but the findings are inconclusive. This study aims to investigate whether GJH, based on different Beighton score cut-off points, is a potential risk factor for injuries in pre-professional dancers. Four cohorts of first-year pre-professional dancers (N = 185), mean age 19.1 ± 1.3 years, were screened on musculoskeletal functioning at the start of their academic year. The Beighton score was used to measure GJH. During the academic year, the dancers completed monthly questionnaires about their physical and mental health. Based on the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC), three injury definitions were used (i.e., all complaints, substantial injury, and time-loss injury). To examine potential risk factors for injuries, univariate and multivariate regression models were applied. The response rate of monthly completed questionnaires was 90%. The overall mean (SD) Beighton score was 2.8. The 1-year injury incidence proportion was 67.6% (n = 125), 43.2% (n = 80), and 54.6% (n = 101) for all complaint injuries, substantial injuries, and time-loss injuries, respectively. The multivariate analyses showed a significant association between a previous long lasting injury in the past year and the three injury definitions (p < 0.05). Pre-professional contemporary dancers are at high risk for injuries and hypermobility. However, these two variables are not associated with each other. Health professionals should take injury history into account when assessing dance students, because this variable is associated with increased injury risk.

Failed Latarjet surgery: why, how, and what next?

BackgroundThe Latarjet procedure is an established and popular procedure for recurrent anterior shoulder instability; however, to our knowledge, few studies have reported on the outcomes of revision for failed Latarjet surgery. We reviewed the causes and management of recurrent instability after previous Latarjet stabilization surgery. The outcomes of revision surgery were also evaluated.MethodsA retrospective analysis of prospective data in patients undergoing revision surgery after failed Latarjet stabilization was conducted. Data were collected over a 5-year period and included patient demographics, clinical presentation, cause of recurrent instability, indications for revision surgery, intraoperative analysis, outcomes of revision surgery, and return to sport.ResultsWe identified 16 patients (12 male and 4 female patients) who underwent revision surgery for recurrent instability after Latarjet stabilization. Of these patients, 11 were athletes: 9 professional and 2 amateur athletes. The mean age at revision was 29.9 ± 8.9 years (range, 17-50 years). The indications for revision were anterior instability in 11 patients, posterior instability in 4, and both anterior and posterior instability in 1. Of the anterior instability cases, 54.5% were due to coracoid nonunion and 36.4% were due to capsular failure (retear). All posterior instability cases had posterior capsulolabral injuries, and the mean Beighton score in this group was 6 or higher. One patient had a failed Latarjet procedure with coracoid nonunion and a posterior labral tear.ConclusionCoracoid nonunion was the most common cause of recurrence after Latarjet stabilization, requiring an Eden-Hybinette procedure. The patients who returned with posterior instability had a high incidence of hypermobility and could be treated successfully by arthroscopic techniques.

Ehlers-Danlos Syndrome Type III (EDS) and Visceroptosis: Getting to the Bottom of This Diagnosis

Introduction: EDS type III is the most common form of EDS, characterized by joint and ligamentous hyperlaxity. The diagnosis is made entirely by clinical parameters without any genetic testing available. Functional gastrointestinal (GI) symptoms are present in majority of EDS patients with variable severity. Visceroptosis, defined as prolapse of abdominal organs below their natural position, has been proposed as a cause of functional GI symptoms in EDS. To date, no objective radiographic measurement exists to determine and quantify visceroptosis/enteroptosis. Methods: Subjects with EDS type III fulfilling Rome IV criteria for irritable bowel syndrome were included. Patients with previous abdominal surgeries were excluded. Clinical history and Beighton scores were recorded. Following ingestion of 16 oz barium, the passage of contrast was followed through the small bowel until it reached the colon. At that point, supine and upright radiographs of the abdomen were obtained. Measurements were calculated on supine and fully upright positions with respect to a reference line drawn across the top of the iliac crests. Dynamic measurements included: the lowest point of stomach, bottom of small bowel column in the pelvis, inferior tip of the liver, and top of jejunal column. (Figures 1 & 2) Correction for patients’ height was made by normalizing data to the height of T12 vertebral body.469_A Figure 1. Baseline measurements for assessment of visceroptosis in supine position with respect to line drawn across iliac crest: (A) inferior tip of the liver, (B) bottom of small bowel column in the pelvis, (C) top of jejunal column, (D) lowest point of stomach.469_B Figure 2. Assessment of the drop of four measurements in upright position. (A) inferior tip of the liver, (B) bottom of small bowel column in the pelvis, (C) top of jejunal column, (D) lowest point of stomach.Results: Seven subjects were enrolled (100% Female, mean age 28.3 years, mean Beighton score 6.9). All subjects had abdominal pain and bloating. Constipation, dyspepsia, and nausea were present in 84% and 14% had diarrhea. Gastric emptying delay and Postural Orthostatic Tachycardia Syndrome (POTS) was present in 3 and 4 subjects, respectively. All four visceroptosis measurements showed a descent in upright position (table 1). The most significant descents were seen with the top of jejunal column (7.6 cm) and the lowest point of stomach (5.3 cm). Measurement of the bottom of small bowel column in the pelvis showed the least quantifiable drop (2.0 cm). Lack of significant variability in symptoms did not allow for correlation analysis. Respectively, stomach descended 2.9 and 1.2 cm more in EDS patients with POTS or gastroparesis; however, it did not reach clinic significance Conclusion: Our study offers a simple, inexpensive and objective radiographic approach to quantify and define visceroptosis/enteroptosis in EDS patients. These results need to be validated in larger controlledstudies.469_C Figure 3. Absolute and normalized visceroptosis measurements in EDS type III patients.

Anatomic physeal-sparing technique for medial patellofemoral ligament reconstruction in skeletally immature patients with ligamentous laxity.

To evaluate the clinical outcome of this modified physeal-sparing technique for MPFL reconstruction in skeletally immature patients with ligament laxity. This study was conducted on 16 patients (11 females and 5 males) with an average age of 11.5 years (8-15). They all had recurrent patellar dislocation with generalized ligament laxity (mean Beighton's score of 7) and no patellar tilt on X-ray. We modified the Frank Noyes' non-anatomic technique for MPFL reconstruction to become anatomic without hardware fixation for the graft. The mean follow-up period was 29.25 months (SD 4.3) ranged from 24 to 34 months. Preoperative Kujala score had ranged from 49 to 61 points (mean of 56, SD 4.72), improved to be ranged from 90 to 99 points (mean 94, SD 2.73), which is considered highly significant (p value < 0.005). Till the latest follow-up, there were no definite re-dislocation episodes in any of our patients. The described technique allows reconstruction of the MPFL in skeletally immature patients with ligament laxity avoiding any potential risks of growth disturbances or chondral damage as compared to other techniques. The modification of two-point femoral fixation allows both a more anatomic and more secure form of reconstruction and is cost-effective without the need for hardware.

Factors associated with pain in children with hypermobility – a pilot study

Objectives To explore the relationships between the degree of musculoskeletal pain, pain associated with disability and quality of life are affected by having hypermobile joints. Methods Young people aged between 8-14 were recruited from the rheumatology based Non-Inflammatory Musculoskeletal Pain Clinic at Great Ormond Street Hospital over a 12 month period. They were assessed using biomechanical measures (muscle strength and degree of hypermobility), sensory processing using Quantitative Sensory Testing and psychological measures of anxiety, depression and pain coping styles using validated questions. Full Ethics approval was granted. Results 30 children were recruited (18 female: 12 male); mean age 11.08 with 77% being Caucasian. The mean Beighton score was 6.79/9. All patients reported pain mainly affecting lower limbs with an average score of 49/100 VAS. Degree of hypermobility did not have any impact. Reduced muscle strength was associated with increased pain and reduced quality of life. Other measures were compared to the norms for healthy children. Children with hypermobility appeared to demonstrate increased depression, negative mood, anhedonia and increased anxiety. They demonstrated reduced quality of life specifically with school, emotional well being, physical health and psychosocially. The subjects also had reduced sensitivity to touch including hot and cold. Conclusion The pain experienced by children with hypermobile joints is complex and includes biomechanical, sensory, psychological and social factors. This pilot study is planned to be expanded into a multi-centred project depending upon funding

AB0866 Presence of Acrocyanosis in Patients with Joint Hypermobility

BackgroundJoint hypermobility is a common but often poorly recognized connective tissue condition with joint laxity in the absence of any hereditary systemic disease. Acrocyanosis is symmetric, painless, blue discoloration in...

HYPERMOBILITY: A RISK FACTOR FOR FAILURE FOLLOWING ACL RECONSTRUCTION

Hypermobility is associated with increased risk of sporting injuries. This study was performed to assess the risk of failure following primary ACL reconstruction in patients with hypermobility. Prospective data were...

GENERALIZED LIGAMENT LAXITY AND HIP ARTHROSCOPY IN AN ATHLETIC POPULATION

This study was performed to assess the incidence of generalized ligament laxity (GLL) in patients undergoing hip arthroscopy for intraarticular hip pathology diagnosed by clinical examination and confirmed with magnetic...

HYPERMOBILITY- A RISK FACTOR FOR RECURRENT SHOULDER DISLOCATIONS

BackgroundHypermobility is associated with increased risk of sporting injuries. This study was performed to assess the risk of recurrent shoulder dislocations in patients with hypermobility.MethodsProspective data was collected for 38...

The relationship between joint mobility and motor performance in children with and without the diagnosis of developmental coordination disorder

BackgroundThe purpose of this study was to determine whether joint mobility is associated with motor performance in children referred for Developmental Coordination Disorder (DCD-group) in contrast to a randomly selected group of children between 3–16 years of age (Random-Group).Methods36 children with DCD and 352 typically developing children (Random-Group) participated. Hypermobility was classified based on the Beighton score (cut-off ≥5 for 3–9 years and ≥4 for 10–16 years) using goniometry. Motor performance was assessed with the Movement Assessment Battery for Children (MABC).ResultsThe mean Beighton score in the DCD-group was 5.0 versus 2.6 in the Random group. Prevalence of hypermobility was higher in the DCD-group than in the Random Group (64% and 33% respectively; χ 2 = 16.09, p < .001). There was a significant [negative] correlation (rp = −.38, p = .02) between Beighton score and total MABC scores within the DCD group, but not in the Random Group (rp = −0.07, p = .20). More specifically, in the DCD group we found a significant negative correlation between the MABC total score and the degree of hyperextension of the knees.ConclusionThe extremely high prevalence of hypermobility when applying the recommended cut-off scores stresses the need for an international agreement on firm cut-off points and the use of standardized measurement of Beighton mobility manoeuvres. The results of this study show that a cut-off of 7 is more appropriate, resulting in a prevalence of 6% in children aged 3–16 years. Although in the general population motor performance and joint mobility are not related, this is the case in children referred for DCD. We argue that more mobility of the joints may be a disadvantage when motor coordination is poorly developed.

The relationship between benign joint hypermobility syndrome and carpal tunnel syndrome

Benign joint hypermobility syndrome (BJHS) is defined as the presence of musculoskeletal symptoms in persons with generalized joint laxity in the absence of systemic rheumatologic disease. There is an association between soft tissue rheumatism, entrapment neuropathies, and BJHS. The purpose of the study was to identify the relationship between BJHS and carpal tunnel syndrome (CTS). Ninety patients were included in the prospective controlled study. All selected participants were referred to our electrophysiological laboratory with clinical diagnosis of CTS. Subsequently, subjects were divided into two groups as group I and II. Group I included patients with CTS and group II had patients without CTS based on electrophysiological findings. All subjects were assessed for existing BJHS by using the Brighton 1998 criteria. Fifty-five patients were recruited into group I (CTS) and 35 subjects were in group II. The mean age in group I and II was 49.5+/-10.8 and 40+/-9.9 years, respectively. The subjects in group II were younger than those in group I (p<0.05). The mean Beighton score was 2.04+/-2.7 and 1+/-1.68 in groups I and II, respectively. In patients with CTS, BJHS rate was markedly higher than those in patients without CTS with respect to Brighton 1998 criteria (p<0.0001). There was a positive correlation between CTS and BJHS (r=0.59, p=0.0001). Consequently, we suggested that BJHS could be a predisposing factor for CTS or vice versa.

The frequency of hypermobility and its relationship with clinical findings of fibromyalgia patients

The etiology and pathogenic mechanisms of fibromyalgia (FM) are unknown. A number of studies have suggested that there was a link between hypermobility and FM. In this study, we aimed to expose the frequency of hypermobility in FM patients and its relation with clinical findings. For this reason, 236 women (118 FM women as study group and 118 healthy women as control group) were enrolled in the study. Joint hypermobility was evaluated in the participants by using Beighton scoring system. The rate of joint hypermobility among FM patients (Beighton score of at least 4 or more) was found to be higher than the control group (46.6 vs 28.8%). This result was also statistically meaningful (p<0.05). In addition, the mean Beighton score of FM group was observed to be higher than the control (3.68 vs 2.55, p<0.001). Although not reaching statistical difference (p>0.05), more severe clinical findings were observed in FM patients with hypermobility when compared with ones without.

Joint mobility in adult patients with groin hernias.

The basic mechanisms of hernia formation remain mostly unknown, but several studies suggest that a connective-tissue pathology, affecting mainly the collagen metabolism, could play a role in the genesis of groin hernias. It would be interesting to know if this pathology can express some clinical signs other than the hernia. Our study focused on the joint mobility and the diagnostic criteria for benign joint hypermobility syndrome. Sixty male adult patients with inguinal hernias and 62 control subjects without hernias, age-matched, were compared, taking into account anamnestic criteria (family history of groin hernia, joint sprain, joint dislocation, skin striae, major arthralgia) and joint mobility. This was assessed by using Beighton criteria and measuring the range of movement of five joints (extension of the fifth finger, thumb, wrist, elbow, and knee). The frequency of the positive anamnestic criteria was not statistically different between the two groups. Nevertheless, a family history of groin hernia was observed in 25% of the hernia patients, against 16% in the control subjects ( P=0.23). The mean Beighton score was 0.30 in the hernia patients and 0.29 in the control population. The movement range of the five examined joints was similar in the two groups. In conclusion, patients with a groin hernia presented neither joint hypermobility nor clinical evidence of a benign joint hypermobility syndrome. Although abnormal collagen metabolism is likely implicated in hernia formation, this pathology does not seem to have clinical repercussion on joint mobility.