summary Congenital Dislocation of the Knee is a congenital knee condition that is primarily seen in patients with myelomingocele, arthrogryposis, or Larsen's syndrome. Diagnosis is made clinically with a hyperextended knee at birth. Treatment is a trial of reduction with manual manipulation and casting until the age of 3 months. Surgical management is indicated in cases of failure to gain 30° of flexion after 3 months of casting. Etiology 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 developmental dysplasia of the hip 50% will have hip dysplasia affect one or both hips clubfoot metatarsus adductus Classification Tarek graded by passive range of flexion and radiologic appearance can guide treatment Tarek Classification Radiology Range of passive flexion Grade I Simple recurvatum > 90° Grade II Subluxation/dislocation 30° - 90° Grade III Dislocation < 30° Presentation Presents with hyperextened knee at birth Treatment Nonoperative treatment reduction with manual manipulation and casting indications login to view 4 more bullets technique login to view 1 more bullet Operative treatment surgical soft tissue release indications login to view 2 more bullets goal of surgery is to obtain 90° of flexion login to view 5 more bullets postoperative login to view 1 more bullet