[Ultrasound diagnosis of congenital knee dislocation]. / Sonographie der angeborenen Knieluxation.

Since 1990, more than 50 children with hyperextended knee joints have been treated based on sonographic assessment. Ultrasound imaging has been useful for primary diagnosis, classification, and follow-up of conservative treatment. The image quality of sonographic documentation more or less equates the more expensive magnetic resonance imaging (MRI) and has become the golden standard of imaging hyperextended knee joints. There is almost no more need for plain X-rays.

[Ultrasound imaging of congenital knee joint dislocation. Value in diagnosis and therapy]. / Die sonographische Darstellung der kongenitalen Kniegelenksluxation. Stellenwert in Diagnostik und Therapie.

Congenital dislocation of the knee is a uncommon malformation. Frequently there is an association with other congenital deformities including congenital dislocation of the hip. The classification of Leveuf and Pais into three separate groups (Type A, Type B, Type C) is now widely accepted. Between October 1989 and April 1995 we evaluated ten children (five girls and five boys) with twelve dislocated knees. Clinical, radiographic and different ultrasonography examinations were carried out on both knees. The sonographic classification showed Type A in 3, Type B in 5 and Type C in 4 cases. The sonographic examination revealed the essential anatomic structures and their pathomorphology. The anterior and the posterior cruciate ligament could be demonstrated in the majority of the cases. Three dislocated knees showed an obliteration of the recessus suprapatellaris and fibrotic changes in the m. quadriceps. These cases required operative treatment. With conservative treatment we achieved a satisfactory result in eight children with nine disease knees. There was a good functional result with an average flexion of 106 degrees. Early conservative treatment recommend as the therapy of choice. Ultrasonography imaging offers the possibility of reliable differentiation into one of the three groups of the classification of Leveuf and Pais. Radiographic documentation during the therapy has become the exception. Ultrasonography imaging helped substantially in the decision making and the timing of operative treatment.

Congenital dislocation of the knee.

Congenital dislocation of the knee is a very rare condition, the incidence in Scandinavia hitherto not being known with certainty. Thirteen patients treated during the years 1960 to 1983 with 19 affected knees were reviewed and followed up. Findings of muscular imbalances in nine of these cases and of spinal abnormalities in four cases strongly indicate neuromuscular imbalance as an aetiological factor. The minimum incidence was estimated to be 0.017 per mille or approximately 1 per cent of the incidence of congenital dislocation of the hip. Recommendations for treatment are that manipulation should be carried out gently, and if not successful within 2-3 months and in all cases of Grade III, an operation is indicated. Too many newborn children in this series had manipulation fractures or slipped epiphyses. However, signs of fracture had disappeared at follow-up in most cases.