This document discusses congenital dislocation of the knee and anterior dislocation of the knee and lunate. It describes congenital dislocation of the knee as occurring due to developmental issues and having three degrees of severity from hyperextension to full dislocation. Treatment ranges from casting to surgery depending on severity. Acute knee dislocation is usually from trauma and may require surgery if closed reduction fails or there are ligament injuries. Anterior dislocation of the lunate can cause median nerve compression and disability if not reduced emergently, either closed or through open reduction depending on when treatment occurs.

1. -ANAKHA P

3. • Complex synovial joint.
STABILISERS OF KNEE JOINT
 2 TYPES STATIC AND DYNAMIC
STATIC
Joint capsule
Collateral ligaments
Medial patellofemoral ligament
INTRODUCTION

5. DYNAMIC
Quadriceps
Biceps femoris
Pes anserinus
Gastocnemius
Tensor facia lata
Semimembranous
Popliteus

7. Dislocation can be :
 Congential
 Acute

8. CONGENITAL DISLOCATION
OF KNEE
• Traumatic developmental - due to malposition in uterus.
• Defects like spina bifida.
• Quadriceps contracture
• congenital absence or hypoplastic anterior cruciate ligament.

9. Three degrees :
 Congenital hyperextension.
 Congenital hyperextension with anterior subluxation of tibia on
femur.
 Congenital hyperextension with anterior dislocation of tibia on
femur

10. Clinical Features
 The patient presents with hyperextension deformity of the knee
and could be quite grotesque.
 The knee functions are affected.
 The patient complains of limp and difficulty in carrying out his
knee functions.

12. Pathology
 Varies with severity but anterior capsule and quadriceps are
contracted.
 There are always intraarticular adhesions, hypoplasia or absence
of patella or lateral dislocation of patella, and hypoplastic vastus
lateralis.

13. Radiograph
Plain X-ray of the knee including both AP and lateral views.

15. Treatment
 Mild to Moderate :
Conservative methods like Pavlik harness, serial casting and
skeletal traction are the treatment of choice.

16.  Severe :
In severe cases, surgery is indicated and is done by anteromedial approach.
 Surgery should be done before the child is 2 years of age.
 Two surgical methods are described: Neibauer and King Technique
is a Z-plasty of quadriceps.
 Curtis and Fischer Quadriceps above patella is divided by inverted
V-incision

17. ACUTE DISLOCATION OF KNEE
 Due to RTA, fall, etc.
 It is usually associated with injuries to collateral cruciates and meniscus.
 Patella may also be fractured or dislocated.

19. Treatment:
 Conservative:
 An attempt may be made for closed reduction under GA.
 An above knee POP cast is applied for 12 weeks.

20.  Surgery:
 Open reduction may be required if the closed reduction fails or if
there is extensive ligament injuries, which may require repair,
reconstruction or both.
 Knee is immobilized in above knee POP cast for 12 weeks.

23. ANTERIOR DISLOCATION
OF LUNATE
It is a common carpal dislocation and can lead to severe disability of the
wrist function.

24. Mechanism of Injury
 This is due usually due to fall on the out-stretched hands.
 It can cause late carpal instability and arthritis.

25. Clinical Features
Patient presents with pain, swelling, tenderness and loss of wrist
movements.

26. Radiograph
Lateral view, normally lunate forms a half-moon shape, which is lost in this
dislocation. Moreover, in the anteroposterior view the normal rectangular
profile is lost.

27. Treatment Problems
 This may cause compression of the median nerve.
 If left untreated it may cause permanent palsy, hence, reduction
should be carried out as an emergency procedure.

28. Methods
 If seen early, reduction is easy and immobilization for 3 weeks
with wrist in slight flexion usually gives good results.
 If seen after 3 weeks, open reduction is done.
 If lunate cannot be reduced by open reduction, resection of the
proximal carpal bones or arthrodesis of the wrist may be
necessary.