Second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACL-R) is a dreaded potential complication to both patients and healthcare professionals.1 Research conducted throughout the 2010s has helped identify factors influencing second ACL injury risk after ACL-R and the multifactorial causes of second ACL injury are now well established, with patient anatomy, surgical factors and components of the rehabilitation process each playing essential roles.2 Despite the wealth of existing knowledge, additional contributors to second ACL injury may be overlooked due to the focus on complex interactions between a subset of risk factors. To avoid missing the forest for the trees, we cannot afford to overlook more straightforward reasons that lead to second ACL injuries. Generalised joint hypermobility (GJH) is one such contributor to the increased risk of reinjury after primary ACL injury. This editorial presents the rationale for an assessment of GJH in all patients with an ACL injury.

A clinical phenotype with a heterogeneous genetic background, GJH is characterised by increased mobility in multiple synovial joints.3 The assessment of GJH is conducted with the Beighton score,4 determined by the positive results of joint mobility tests (figure 1). The tests are evaluated on a nine-point scale, and a cut-off value (typically four or five) indicates GJH. Cut-off scores for GJH may vary by age, pubertal status and patient sex. However, consensus is currently lacking regarding the Beighton score cut-off for GJH, …