Limited Open Quadriceps Release for Treatment of Congenital Dislocation of the Knee.

BACKGROUND: Congenital dislocation of the knee (CDK) is a rare condition for which the treatment is difficult and remains controversial. The aim of this case series is to evaluate the results of limited open quadriceps release for treatment of CDK.

METHODS: Sixteen patients with CDK were managed at our institute from May 2006 to May 2014, and included 10 boys and 6 girls, with a mean age at presentation of 5 weeks (range, 1 to16 wk). Three patients who had an underlying neuromuscular syndrome were excluded. The remaining 13 patients had no identifiable syndrome. There were 9 bilateral cases and 4 unilateral, with a total of 22 dislocated knees. Treatment began with gentle manipulation and serial weekly long-leg plaster casting in the outpatient clinic. Limited open quadriceps release was performed after failure of conservative treatment or in cases that presented late (>12 wk). The mean follow-up was 26.8 months (range, 12 to 48 mo).

RESULTS: Manipulation and serial casting were successful in 6 knees. The mean postmanipulation passive arc of range of motion of the affected knees was 118 degrees (range: 100 to 140 degrees). At final follow-up, the knee outcome was excellent in 2 knees and good in 4 knees. Sixteen knees were managed by limited open quadriceps release. The age of the patients at the time of surgery ranged between 8 and 16 weeks with a mean of 10 weeks. The mean postoperative passive arc of range of motion of the affected knees was 110 degrees (range: 95 to 145 degrees). Minor degrees of flexion deformity at the knee were encountered frequently (mean 8.5 degrees). Slight instability was observed in 6 cases. At final follow-up, the knee outcome was excellent in 6 knees and good in 10 knees.

CONCLUSIONS: Management of CDK preferably should be started early with gentle manipulation and serial casting. Failure of conservative treatment or delayed presentation will need surgical intervention. Limited open quadriceps release has satisfactory results.

LEVEL OF EVIDENCE: Level IV-case series.