Congenital dislocation of the knee surgical management

ABSTRACT

This paper reported 12 complete congenital dislocations of the knee in 8 children. The average age at presentation was 9 months. The patient's age at the time of surgery ranged between three months and three years with an average of nine months. It was not possible in any case to flex the knee beyond 0 degree of extension. A deep anterior transverse skin fold at the level of the joint was found in all cases. Surgery was generally required for congenital pathologic subluxation and dislocation. The essential abnormality needing operative correction was severe fibrosis of the distal quadriceps with subsequent shortness and contracture. The operation was performed with the patient in the supine position without a tourniquet. The incision was a long anterior incision that extended from the distal half of the thigh to the proximal part of the tibia to expose the distal two thirds of the quadriceps mechanism and the knee joint. The patients were followed up from 1-5 years following operation, with a mean follow up of 3 years. All patients were able to walk freely without an external aid. Several series in the literature reported a spectrum of hyperextension deformities of the knee, varying from simple or physiologic hyperextension to complete pathologic dislocation. It is difficult to correct the equinovarus deformity of the foot caused by tension on the gastrocnemius when the knee cannot be flexed sufficiently. Thus, a reduction of the knee joint first is considered to be essential for producing the correct alignment of the lower limb