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Congenital Dislocation of the Knee

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Topic updated on 10/28/14 6:36am
Introduction
  • Spectrum of disease including
    • positional contractures
    • rigid dislocation
  • Structural components include
    • quadricep tendon contracture
    • anterior subluxation of hamstring tendon
    • absent suprapatellar pouch
    • tight collateral ligament
  • Often occurs in children with
    • myelomeningocele
    • arthrogryposis
    • Larsen's syndrome
  • Associated conditions
    • often associated with developmental dysplasia of the hip, clubfoot, and metatarsus adductus
      • 50% of patients with congenital knee dislocations will have hip dysplasia affect one or both hips
Presentation
  • Presents with hyperextened knee at birth
Treatment
  • Nonoperative treatment
    • reduction with manual manipulation and casting
      • indications
        • most cases can be treated nonoperatively
        • if both knee and hip dislocated, then treat knee first
          • cant get Pavlik harness on hip if knee dislocated
      • technique
        • long leg casting on weekly basis
  • Operative treatment
    • sugical soft tissue release
      • indications
        • if failure to gain 30 degrees of flexion after 3 months of casting
      • goal of surgery is to obtain 90 degrees of flexion with
        • quadriceps tendon lengthening (V-Y quadricepsplasty or Z lengthening) 
        • anterior joint capsule release
        • hamstring tendon posterior transposition
        • collateral ligaments mobilization
      • postoperative
        • cast in 45 to 60 degrees of flexion for 3 to 4 weeks

 

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