Repeated orthopedic interventions and delayed recognition of generalized hypermobility spectrum disorder: a case report with patient perspective

Generalized hypermobility spectrum disorder (G-HSD) is a clinical diagnosis characterized by symptomatic generalized joint hypermobility with associated musculoskeletal manifestations. Evidence regarding orthopedic surgical outcomes in hypermobile populations remains limited, heterogeneous, insufficient for definitive procedure-specific conclusions, and frequently lacks long-term follow-up. This case is notable for recurrent, anatomically distinct orthopedic events and repeated surgical interventions occurring before recognition of an underlying hypermobility disorder. A 40-year-old woman was clinically diagnosed with G-HSD after a longitudinal history of recurrent left knee instability requiring multiple anterior cruciate ligament reconstructions, progressive knee degeneration treated with semi-constrained total knee arthroplasty, and recurrent right quadriceps tendon rupture requiring two surgical repairs. Following referral to a specialized hypermobility clinic, management shifted toward education and staged stabilization-focused rehabilitation. At the follow-up, bilateral knee range of motion was 20 0 of hyperextension to 140 0 of flexion, quadriceps strength was 5/5 bilaterally, hamstring strength was 4/5 bilaterally, and gait pattern was normal. The Bristol Impact of Hypermobility score decreased from 184/360 to 164/360, and no further orthopedic surgery was documented over approximately three years. Additional patient-reported outcomes demonstrated preserved physical function. A qualitative patient-perspective interview further highlighted the physical, emotional, and healthcare-related impact of repeated surgical interventions and delayed recognition of hypermobility. This case illustrates recurrent instability, soft-tissue injury, and multiple orthopedic procedures preceding recognition of G-HSD. The findings highlight the potential value of considering structured hypermobility assessment in selected patients with recurrent atraumatic or minimal-trauma instability, repeated soft-tissue injury, or unexplained surgical failure. Earlier recognition may help inform individualized rehabilitation and multidisciplinary management although prospective studies are required to determine whether this changes orthopedic outcomes.