Download - Congenital knee dislocation
CONGENITAL HYPEREXTENSION AND DISLOCATION OF THE KNEEBY: DR. MAHWISH KHAN
Introduction
Spectrum of disease including positional contractures rigid dislocation
Introduction Cont…
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
Structural Components
anterior capsule of the knee and quadriceps mechanism are contracted
intraarticular adhesions hypoplasia or absence of the patella fibrosis and loss of bulk of the vastus lateralis muscle suprapatellar pouch was obliterated by the adherent
quadriceps tendon Lateral displacement of patella
Clinical Presentation
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Presents with hyperextend knee at
birth
Grades of Congenital Hyperextension of the Knee
Congenital hyperextension of the knee is divided into three grades according to severity: Grade 1, congenital hyperextension Grade 2, congenital hyperextension with anterior
subluxation of the tibia on the femur and Grade 3, congenital hyperextension with anterior
dislocation of the tibia on the femur
A, Congenital hyperextension. B, Subluxation of knee. C, Dislocation of knee.
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Newborn with bilateral dislocations
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Note prominence of femoral condyles posterior to anteriorly dislocated tibia and fibula
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Anterior displacement of tibia and fibula is evident on lateral radiograph.
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Treatment
Depends upon Severity of subluxation or dislocation and The age of the patient
Non Operative Treatment
Reduction with manual manipulation and casting indications
most cases can be treated non-operatively if both knee and hip dislocated, then treat knee first
technique long leg casting on weekly basis
Excellent results at 5-Year Follow up
In non-responders------skeletal traction for correction is an option.
Newborn with mild-to-moderate hyperextension or subluxation
Operative Treatment
Surgical soft tissue releaseIndications
if failure to gain 30 degrees of flexion after 3 months of casting
Operative Treatment cont…
Goal Of Surgery : 90 degrees of flexion withquadriceps tendon lengthening (V-Y quadricepsplasty or Z
lengthening)anterior joint capsule releasehamstring tendon posterior transpositioncollateral ligaments mobilization
Curtis and Fisher technique
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Lines of incision to release anterior capsule medially and laterally and medial and lateral retinaculum of quadriceps mechanism
Curtis and Fisher technique
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Correction after soft-tissue release and lengthening of rectus femoris muscle
Operative Treatment cont…
Postoperativecast in 45 to 60 degrees of flexion for 3 to 4 weeks
Rare Cases osteotomy of the femur or tibia may be required in an older child.
After Treatment
cast changed at 2 weeks At 4 to 6 weeks,
the cast is removed active and passive exercises are begun
In Older Patients continuous passive motion can be used to regain motion during the
first 3 to 6 weeks after surgery long leg brace is worn for 6 to 12 months to prevent
hyperextension of the knee.