Evidence-Based Treatment for Congenital Dislocation of the Knee
Various treatment modalities have been proposed for the management of congenital dislocation of the knee, while non-surgical treatment consists of traction, manipulation, serial casting and Pavlik harness application, surgical options include minimally in
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Abdelsalam Hegazy and Talal Ibrahim
Abstract
Various treatment modalities have been proposed for the management of congenital dislocation of the knee, while non-surgical treatment consists of traction, manipulation, serial casting and Pavlik harness application, surgical options include minimally invasive quadriceps tenotomy, open quadricepsplasty and femoral shortening. Most of the reports advocate non-surgical management initially for the reduction of the knee especially in early days after birth. However, there is no consensus regarding the best surgical treatment for the nonresponsive or late presented cases. The paucity of the disease and the frequently associated problems beside the severity of knee dislocation are important factors affecting the treatment outcomes. This is an overview of the available treatment options reported to guide decision-making for the management of congenital dislocation of the knee. Keywords
Congenital dislocation of the knee • Knee hyperextension • Genu recurvatum • Quadricepsplasty • Femoral shortening • Percutaneous tenotomy
Introduction Congenital Dislocation of the Knee (CDK) is a rare spectrum of deformities ranging from simple knee hyperextension (genu recurvatum) to complete knee dislocation, first described by Chatelaine in 1822 [1]. The estimated incidence of CDK is approximately 1 per 100,000 live births [2]. CDK may be an isolated deformity or associated with other musculoskeletal diseases such as developmental dysplasia of the hip and clubfoot. Furthermore, CDK may be part of a syndrome such as Larsen’s syndrome, Arthrogryposis Multiplex Congenita (AMC) or associated with paralytic conditions such as Meningomyelocele (MMC) (Fig. 11.1) [3]. The pathology of CDK is similar in most cases with short quadriceps tendon, tight anterior knee joint capsule
A. Hegazy • T. Ibrahim (*) Hamad Medical Corporation, Doha, Qatar e-mail: [email protected]; [email protected]
and hypoplastic suprapatellar pouch with anteriorly subluxed hamstrings. However, the severity of these changes is exaggerated in complex cases and associated with secondary changes in bones and ligaments in long standing deformities [4]. The clinical presentation of knee recurvatum leads easily to early diagnosis and can be confirmed by radiography [5, 6]. The relation between the tibia and femur clinically and radiographically allows for a simple classification of CDK into recurvatum, subluxation and dislocation (Leveuf’s Classification). The simple form of genu recurvatum is usually related to fetal molding due to oligohydramnios or breech position as been suggested by Haga et al. [7]. The other classification system was proposed by Finder in 1964 dividing CDK into five types according to the severity of the dislocation and its complexity. Type 1 being physiologic hyperextension up to 20° and type 5 being a complex variant including mixed categories of congenital diseases such as Ehlers-Danlos syndrome and Arthrogryposis [8] (Table 11.1, Fig. 11.2).
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