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Updated: Jun 14 2021

Congenital Dislocation of the Knee

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  • 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
          • 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
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