Brooks Jaysson T, Ramji Alim F, Lyapustina Tatyana A, Yost Mary T, Ain Michael C
*Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center †The Johns Hopkins School of Medicine ‡The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Pediatr Orthop. 2017 Jan;37(1):e43-e47. doi: 10.1097/BPO.0000000000000662.
Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions.
We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014. Demographic data were reviewed, as well as any documentation of ACL or PCL injury or reconstruction. We called all 430 patients by telephone, and 148 agreed to participate in our survey, whereas 1 declined. We asked these patients about their history of ACL or PCL injury or reconstruction, as well as current and past physical activity levels.
No ACL or PCL injuries were found on chart review. One patient reached by telephone reported an ACL injury that did not require reconstruction. This yielded a theoretical prevalence of 3/430 (0.7%). Of the 148 patients surveyed, 43 (29%) reported low physical activity, 75 (51%) reported moderate physical activity, and 26 (17%) reported high physical activity. There was no significant difference in the rate of ACL injury when stratified by physical activity level (P=0.102).
ACL and PCL injuries and reconstructions are extremely rare in patients with achondroplasia, which cannot be completely ascribed to a low level of physical activity. One possible explanation is that patients with achondroplasia, on an average, have a more anterior tibial slope compared with those without achondroplasia, which decreases the force generated within the ACL and may protect against ACL injury. Further research is needed to explore possible causes.
Level IV-retrospective review.
前交叉韧带（ACL）和后交叉韧带（PCL）损伤及其后续重建在普通人群中很常见，但对于最常见的骨骼发育不良——软骨发育不全患者的ACL或PCL损伤，尚无相关研究。我们的目标是：（1）评估青少年和成年软骨发育不全患者中ACL和PCL损伤的患病率；（2）将该患病率与普通人群报告的患病率进行比较；（3）确定有多少ACL或PCL损伤患者接受了韧带重建治疗；（4）确定患者的活动水平与ACL/PCL损伤及重建率之间的关系。
我们回顾了2002年至2014年资深作者诊所中430例软骨发育不全患者的病历。审查了人口统计学数据以及任何有关ACL或PCL损伤或重建的记录。我们给所有430例患者打电话，148例同意参与我们的调查，1例拒绝。我们询问这些患者有关ACL或PCL损伤或重建的病史，以及当前和过去的身体活动水平。
病历审查未发现ACL或PCL损伤。通过电话联系到的1例患者报告了1次无需重建的ACL损伤。这得出理论患病率为3/430（0.7%）。在接受调查的148例患者中，43例（29%）报告身体活动水平低，75例（51%）报告身体活动水平中等，26例（17%）报告身体活动水平高。按身体活动水平分层时，ACL损伤率无显著差异（P = 0.102）。
软骨发育不全患者中ACL和PCL损伤及重建极为罕见，这不能完全归因于身体活动水平低。一种可能的解释是，与非软骨发育不全患者相比，软骨发育不全患者平均胫骨前坡度更大，这会降低ACL内产生的力，可能预防ACL损伤。需要进一步研究以探索可能的原因。
IV级——回顾性研究。
