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 developmental dysplasia of the hip 50% will have hip dysplasia affect one or both hips clubfoot, metatarsus adductus Classification Tarek CDK Classification Graded by passive range of flexion and radiologic appearance Can guide treatment Presentation Presents with hyperextened knee at birth Treatment Nonoperative treatment reduction with manual manipulation and casting indications Tarek GI, initial treatment for GII (up to 1 month of age) most cases can be treated nonoperatively if both knee and hip dislocated, then treat knee first can't get Pavlik harness on hip if knee dislocated technique long leg casting on weekly basis Operative treatment surgical soft tissue release indications failure to gain 30° of flexion after 3 months of casting Tarek GII (identified after 1 month of age), GIII, and in recurrent cases goal of surgery is to obtain 90° of flexion percutaneous quadriceps recession (PQR) 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° flexion for 3 to 4 weeks
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07PE.94) Figures 43a and 43b show the clinical photographs of a 4-month-old child with bilateral popliteal pterygium. The fixed knee contractures measure 100 degrees bilaterally. What future treatment is most likely to successfully correct this deformity? Review Topic QID: 6154 FIGURES: A B 1 Serial casting of both knees weekly 13% (6/45) 2 Physiotherapy and dynamic splinting 2% (1/45) 3 Soft-tissue releases of the knees, including Z-plasties of skin, excision of fibrotic bands, hamstring lengthenings, and posterior knee capsulotomies 56% (25/45) 4 Femoral shortening osteotomies combined with soft-tissue releases of the knees (Z-plasties of skin, excision of fibrotic bands, hamstring lengthenings, and posterior knee capsulotomies) 24% (11/45) 5 Gradual correction with a circular external fixator without soft-tissue release 2% (1/45) N/A Select Answer to see Preferred Response PREFERRED RESPONSE 4 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK