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Congenital dislocation of the knee
H Bensahel1, A Dal Monte, A Hjelmstedt
1Department of Pediatric Orthopaedics, Hôpital Robert Debré, Paris, France.
Insights
Congenital dislocations of the knee (CDK) are rare pediatric conditions. Conservative treatment, including physiotherapy and splinting, yielded better results than surgical interventions for CDK.
Area of Science:
- Orthopaedics
- Paediatric Medicine
- Congenital Abnormalities
Background:
- Congenital dislocations of the knee (CDK) are exceptionally rare, occurring significantly less frequently than congenital dislocations of the hip (CDH).
- A multicentric study identified 56 cases of CDK in 46 infants, often associated with other malformations and consistent muscular abnormalities at the knee.
- Leveuf's classification identified grade 3 (complete dislocation) as the most prevalent form of CDK.
Purpose of the Study:
- To analyze the incidence, associated conditions, and treatment outcomes of congenital dislocations of the knee.
- To compare the efficacy of conservative versus surgical management strategies for CDK.
Main Methods:
- Retrospective analysis of 56 congenital dislocation of the knee cases from a European Paediatric Orthopaedic Society multicentric study.
- Review of treatment approaches, including conservative methods (physiotherapy, rigid splinting) and surgical interventions focusing on the extensor apparatus.
- Evaluation of treatment outcomes based on knee flexion range and knee stability.
Main Results:
- Conservative treatment was applied to 24 patients with CDK.
- Surgical interventions involved progressive release and lengthening of the quadriceps tendon in all operated cases.
- All treatment modalities achieved a knee flexion range of 120 degrees; however, conservative treatment demonstrated superior outcomes with only two cases of instability.
Conclusions:
- Congenital dislocations of the knee require careful management, with conservative approaches showing promising results.
- Early physiotherapy and splinting may be effective, while surgical intervention necessitates addressing extensor apparatus abnormalities.
- Further research into optimal treatment strategies for CDK is warranted to improve patient outcomes and minimize instability.
Abstract:
Congenital dislocations of the knee (CDK) are rare, occurring 40-80 times more rarely than congenital dislocation of the hip (CDH). In a multicentric study of the European Paediatric Orthopaedic Society, 56 cases of CDK were found in 46 babies. Many other malformations associated with CDK were noticed, and muscular abnormality was always found at the knee. According to the classification of Leveuf, three grades have to be considered: grade 3, or complete dislocation, was the most frequent. At birth, treatment consisted of physiotherapy with rigid splint. Twenty-four patients with CDK have been treated only by the conservative technique. Operations were performed according to the abnormalities of the extensor apparatus: a progressive release and lengthening of the quadricipital tendon was necessary in all cases. In all forms of treatment, the range of the knee flexion was 120 degrees. Only two children had a bad result because of unstable knees. Results were always better with conservative treatment.