Management of severe, neglected, bilateral congenital knee dislocation

Congenital dislocation of the knee (CDK) is a rare condition, often associated with syndromes and other limb anomalies. It is typically diagnosed and treated in early infancy. Neglected cases of CDK can present with significant deformities and loss of function. Their treatment is challenging and scarcely reported in the literature. The primary purpose of this study is to report on management of neglected CDK presenting in second decade of life. Four patients (eight knees) with severe, neglected, bilateral CDK who presented in their second decade of life were identified. Their preoperative radiographs were evaluated for presence of distal femoral dysplasia and compared to age-matched controls. Their clinical presentation, surgical treatment, and outcomes were analyzed at minimum 2 year follow-up. All four patients were 11-12 years old and had severe, bilateral, neglected CDK. Three patients had a quadrupedal gait. Preoperative radiographs showed significant distal femoral dysplasia when compared to controls. Surgical interventions included bilateral open reduction with quadricepsplasty in two patients and femoral flexion-shortening osteotomy (FSO) in two patients. At the latest follow-up, all patients had bipedal gait and improved quality of life. Postoperative radiographs showed improvement in distal femoral dysplasia in patients who underwent open reduction and quadricepsplasty. Patients with neglected CDK can present with quadrupedal gait. Compared to femoral FSO, open reduction and quadricepsplasty appears to be a better surgical treatment option as the latter can help restore joint articulation. Once the joint is reduced, distal femoral dysplasia can remodel to a certain extent. Level of evidence: Case series - Level 4.