Congenital Hyperextension with Anterior Subluxation of the Knee

Curtis, Burr H.; Fisher, Robert L.

doi:10.2106/00004623-196951020-00005

Cited by 121 publications

(89 citation statements)

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“…If the quadriceps tendon and the anterior cruciate ligament are divided, then only fair results are achieved [9]. Treatment options include serial casting, PQR [13], and VYQ [2]. Compared to PQR; VYQ is associated with increased morbidity due to a long incision with scarring, adhesions, and wound breakdown, as well as blood loss; however, it is more successful in achieving and maintaining reduction in severe and resistant cases.…”

Section: Discussionmentioning

confidence: 99%

“…The reduction is felt. VYQ was performed as described by Curtis and Fischer: [2] A long anterolateral incision is made. The central portion of the quadriceps tendon is incised in a fashion to allow V-Y advancement.…”

Section: Methodsmentioning

confidence: 99%

“…It may occur as an isolated deformity, it may be associated with musculoskeletal anomalies such as DDH and clubfoot [2][3][4], or it may occur as part of a syndrome such as arthrogryposis multiplex congenita (AMC) or Larsen syndrome or it may occur in paralytic conditions such as meningomyelocele [1,3].…”

Section: Introductionmentioning

confidence: 99%

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

Abdelaziz

Samir

2011

Journal of Children's Orthopaedics

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Abdelaziz

Samir

2011

Journal of Children's Orthopaedics

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“…An extensile surgical release operation has been described for correcting most complete congenital knee dislocations associated with Larsen syndrome [5,19]. The quadriceps mechanism requires considerable lengthening, although it must remain attached proximally and distally.…”

Section: Discussionmentioning

confidence: 99%

Congenital Knee Dislocation in a Patient with Larsen Syndrome and a Novel Filamin B Mutation

Dobbs

Boehm²,

Grange³

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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We treated a patient with multiple congenital joint dislocations and facial dysmorphisms consistent with Larsen syndrome. Sequencing of the FLNB gene resulted in identification of a novel, de novo 508G[C point mutation resulting in substitution of proline for a highly conserved alanine (A170P). This mutation has not been described previously but is likely causative because this alanine is highly conserved and is located in the calponin homology domain where other mutations have been described. We also report the successful use of a minimally invasive technique in achieving initial correction of bilateral congenital knee dislocations in this patient. The technique consists of serial manipulations and castings followed by an open quadriceps tenotomy. Longer followup is needed to ensure maintenance of correction and to avoid the need for more extensive surgery, which has been the traditional treatment for congenital knee dislocation associated with Larsen syndrome.

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“…Most researchers believe that quadricepsplasty is the best method to improve joint ROM and preserve the strength of quadriceps muscle 14,15,18 . In this study, the surgical method was used, which both improved the joint Rom and preserved the strength of quadriceps muscle at 4/5.…”

mentioning

confidence: 99%

Assessment of outcome of Quadricepsplasty in Knee contractures of patients with arthrogryposis

Moghadam

Birjandinejad

Ghoreishi

2015

Bangladesh J Med Sci

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Arthrogryposis multiplex congenita (AMC) refers to a group of conditions, unrelated to one another, which are similarly characterized by the contracture of multiple joints in the body. One of the common therapies in patients with AMC and knee extension contracture is quadricepsplasty. However, no comprehensive studies have been conducted on the results of the application of this method. This prospective study included 14 patients (9 females and 5 males) with 23 hyperextension contractures of the knee. Before surgery, all patients had underwent non-surgical treatment (manipulation and serial casting) for at least 6 months, but none had responded to the treatment. Then patients underwent a Quadricepsplasty. Range of motion (ROM) of the knee and patients ambulation based on modified form of Functional Mobility Scale (FMS) before and after surgery were evaluated in a follow up 3 years. The mean passive knee ROM before surgery was 7.17° (0° to 15°), which increased to 65.65° (35° to 105°) after the operation. According to t-test results, this increase was statistically significant (P<0.005). The mean ambulation score (modified FMS) of the patients before surgery was 1.57, which increased to 3.71. According to t-test results, this increase was statistically significant (P<0.005). Quadricepsplasty is the method of choice for the surgical treatment of knee extension contracture in AMC patients, who do not respond to non-surgical treatments. This method leads to a significant improvement in knee ROM. On the other hand, it preserves quadriceps strength at 4/5 level, and finally, along with other therapeutic interventions for other lower limb deformities, leads to ambulation improvement in these patients.

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Congenital Hyperextension with Anterior Subluxation of the Knee

Cited by 121 publications

References 0 publications

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

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

Congenital Knee Dislocation in a Patient with Larsen Syndrome and a Novel Filamin B Mutation

Assessment of outcome of Quadricepsplasty in Knee contractures of patients with arthrogryposis

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