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Congenital knee dislocation
- 2. CONGENITAL HYPEREXTENSION AND DISLOCATION OFTHE KNEE BY: DR. MAHWISH KHAN
- 3. Introduction Spectrum ofdisease including positional contractures rigid dislocation
- 4. Introduction Cont… Associatedconditions 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
- 5. Structural Components anteriorcapsule 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
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- 7. Grades of CongenitalHyperextension 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
- 8. A, Congenital hyperextension. B,Subluxation of knee. C, Dislocation of knee.
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- 10. Note prominence of femoralcondyles posterior to anteriorly dislocated tibia and fibula
- 11. Anterior displacement of tibiaand fibula is evident on lateral radiograph.
- 12. Treatment Depends upon Severity of subluxation or dislocation and The age of the patient
- 13. 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
- 14. Excellent results at5-Year Follow up In non-responders------skeletal traction for correction is an option. Newborn with mild-to-moderate hyperextension or subluxation
- 15. Operative Treatment Surgicalsoft tissue release Indications if failure to gain 30 degrees of flexion after 3 months of casting
- 16. Operative Treatment cont… Goal Of Surgery : 90 degrees of flexion with quadriceps tendon lengthening (V-Y quadricepsplasty or Z lengthening) anterior joint capsule release hamstring tendon posterior transposition collateral ligaments mobilization
- 17. Curtis and Fisher technique Linesof incision to release anterior capsule medially and laterally and medial and lateral retinaculum of quadriceps mechanism
- 18. Curtis and Fisher technique Correctionafter soft-tissue release and lengthening of rectus femoris muscle
- 19. Operative Treatment cont… Postoperative cast 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.
- 20. After Treatment castchanged 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.