Congenital Knee Dislocation: A Rare Orthopedic Enigma in Rural Nepal

Congenital knee dislocation (CKD) (genu recurvatum congenitum) is a rare neonatal orthopedic deformity characterized by hyperextension of the knee joint and potentially associated with intrauterine mechanical factors, quadriceps contracture, or syndromic disorders. Early recognition is essential, as prompt conservative management can prevent long-term disability and reduce the need for surgical intervention. The objective of this single case report is to describe a rare presentation of bilateral congenital knee dislocation managed successfully through early conservative treatment in a rural and resource-limited setting of Nepal, highlighting the timeline of improvement and long-term outcome. We report a full-term female neonate born via institutional delivery in a remote region of Dailekh District, Nepal, who presented within 24 hours of birth with bilateral knee hyperextension of approximately 100°, consistent with type II congenital knee dislocation (anterior tibial subluxation without complete dislocation). The neonate was treated with gentle manipulation and serial above-knee plaster casting, with casts changed every 7-10 days to gradually increase knee flexion from 0° to 30°, while the toes were left exposed for monitoring of circulation and swelling due to the remote location of the patient's family. Noticeable improvement was observed after three casting sessions over a four-week period, and by six weeks, both knees achieved near-neutral to mildly flexed resting positions, demonstrating improved alignment and stability. Follow-up radiographs at six weeks, six months, two years, and four years confirmed maintained reduction, normal knee alignment, intact growth plates, and age-appropriate motor milestones without pain, instability, or functional limitations. This case highlights that early diagnosis and conservative management of congenital knee dislocation can achieve excellent long-term anatomical and functional outcomes, even in resource-limited settings and during challenging circumstances, emphasizing the importance of continuous follow-up and parental counseling to ensure adherence and awareness in managing rare congenital orthopedic conditions.