Congenital dislocation of the knee: A protocol for management based on degree of knee flexion

Abstract

Purpose Congenital dislocation of the knee (CDK) is a relatively rare condition. It may occur as an isolated deformity, it may be associated with musculoskeletal anomalies such as developmental dysplasia of the hip and clubfoot, or it may occur as part of a syndrome such as arthrogryposis multiplex congenita or Larsen syndrome, or it may occur in paralytic conditions such as meningomyelocele. Treatment options include serial casting, percutaneous quadriceps recession (PQR) and V-Y quadricepsplasty (VYQ). The aim of this study is to evaluate the medium-term results of PQR and VYQ, and to set a protocol of management for CDK based on a modified grading system. Methods Eleven infants with 21 CDK were treated at our unit. Five knees were treated with serial casting, 12 knees with PQR and four knees with VYQ. Follow up averaged 41 months. Results Twelve knees achieved excellent results, seven knees achieved good results and two knees achieved fair results. Conclusion A modified grading system for CDK is introduced. Based on this, we recommend the following. Serial casting is performed in patients with GI CDK. In GII CDK in neonates (babies up to the age of 1 month) serial casting is started. A maximum of four weekly manipulations and castings are attempted. If a range of flexion [90°i s achieved, serial casting is continued; if range of flexion remains \90°it is necessary to proceed to PQR. In babies older than 1 month when first seen; PQR is performed from the start. VYQ is indicated in patients with GIII CDK or in recurrent cases.

Assessment of clinical outcome of percutaneous needle quadriceps tenotomy in the treatment of congenital knee dislocation

“…Prognosis of CDK depends upon the time of intervention, type of CDK, existing pathology, associated anomalies and generalized hyperlaxity [8,16,17]. In the present series percutaneous needle tenotomy was successfully used in treatment of 12 cases of the flexible variety of CDK with good functional outcome at one to three years of follow up.…”

“…Tarek et al showed good results of PQR in 12 knees with Tarek grade 2 CDK. However, Tarek grade 2 included both subluxation and dislocation with pre-operative knee flexion of 30-90°which may lead to overestimation of beneficial results [17]. Few advantages of PNT over these minimally invasive techniques can be noted.…”

Congenital dislocation of the knee: prenatal diagnostics and treatment at an early age

“…Во всех указанных системах оценивается объем движе-ний и стабильность коленных суставов. Неко-торые авторы добавляют в шкалу оценки боль, удовлетворенность результатом, необходимость использования ортопедических приспособлений, а также быструю утомляемость [4,5,13,20,22,23,25].…”

“…Следует отметить, что авторская методика обес-печивала вправление вывиха голени в среднем за 3 дня, в то время как средний срок коррекции с шиной Розена составил 8 дней, а при этапных гипсовых повязках -25 дней. Таким образом, разработанный нами метод позволил значитель-но сократить сроки лечения [3,5,11,13,21,25,26,28].…”

“…Для оценки степени тяжести ВПВГ при пер-вичном осмотре и по данным записей в историях болезни (ретроспективно) использовались две си-стемы [22,25] …”