en جراحی زانو Knee surgery مروری Review Paper <div style="text-align: justify;"><strong>Background</strong>: Generalized joint hypermobility (GJH), generalized joint laxity (GJL), and knee hyperextension may increase anterior and rotational loads after anterior cruciate ligament (ACL) reconstruction. In these patients, graft choice may influence postoperative stability and failure risk.&nbsp;<br> <strong>Objectives</strong>: This study aimed to review the clinical and mechanistic evidence on graft choice for ACL reconstruction in patients with GJH, GJL, or knee hyperextension.<br> <strong>Methods</strong>: This narrative review used a structured, evidence-based, graft-stratified approach to clinical studies. Outcomes included graft rupture, second ACL injury, measured anterior laxity, pivot shift, and patient-reported knee scores. Mechanistic evidence on graft stiffness, fixation, elongation, and healing was used to interpret the clinical findings.<br> <strong>Results</strong>: Available evidence is limited and mostly observational. Across graft-stratified studies, bone-patellar tendon-bone (BPTB) autograft was associated with lower measured anterior translation than hamstring autograft in laxity-pattern knees. Limited pooled data also favored BPTB for anterior translation and Lysholm score at approximately 24 months. Registry evidence after return to sports suggested higher second ACL rupture and graft rupture rates after hamstring autograft than after BPTB autograft. Quadriceps tendon autograft with a bone block appears promising, especially in knee hyperextension, but direct evidence in systemic hypermobility remains limited.<br> <strong>Conclusion</strong>: In patients with GJH, GJL, or marked knee hyperextension, ACL graft choice should be considered a stability-focused decision. Current evidence most consistently supports BPTB autograft when objective stability is prioritized. Quadriceps tendon autograft with a bone block is promising but requires further study.</div> Anterior cruciate ligament (ACL) reconstruction, Graft choice, Generalized joint hypermobility (GJH), Generalized joint laxity (GJL), Knee hyperextension, Bone-patellar tendon-bone (BPTB), Hamstring tendon, Quadriceps tendon 87 98 http://jros.iums.ac.ir/browse.php?a_code=A-10-2748-1&slc_lang=en&sid=1 Mahmoud Jabalameli jabalamelimd@yahoo.com 10031947532846009322 10031947532846009322 No Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Abolfazl Bagherifard bagherifard.a@iums.ac.ir 10031947532846009323 10031947532846009323 No Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Alireza Askari askarialireza0917@gmail.com 10031947532846009324 10031947532846009324 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Hooman Yahyazadeh yahyazadehhooman@yahoo.com 10031947532846009325 10031947532846009325 No Department of Orthopedic Surgery, Bone and Joint Reconstruction Research Center, Shafa Yahyaeian Hospital, Tehran, Iran. Amir Azimi dr.amir2011@yahoo.com 10031947532846009326 10031947532846009326 No Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Kamal Arjmand arjmand.kamal@gmail.com 10031947532846009327 0009-0003-9388-924X Yes Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Bushra Zareie shafabushra@gmail.com 10031947532846009328 10031947532846009328 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Behnam Sour sourbehnam1374@gmail.com 10031947532846009329 0009-0002-3176-1956 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.