Congenital knee dislocation

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Classification according to ICD-10
Q68.2 Congenital deformity of the knee, including genu recurvatum, knee dislocation
ICD-10 online (WHO version 2019)

The congenital knee dislocation is a congenital subluxation -Fehlstellung the tibia to the femur with hyperextension of the knee. In addition, there is a shortening of the thigh extensor muscles as well as often torsional and valgus malpositions and an absence of the cruciate ligaments and displacement of the kneecap outwards.

This dislocation was first described by Chatelain in 1822.

The frequency of this rare disease is given as 1.5 per 100,000 newborns. A familial accumulation in some cases has been described.

X-ray of a newborn with congenital knee dislocation and also Zellweger syndrome with pin-shaped calcifications in the patella
Sonogram in comparable image orientation, P = patella, F = femoral, T = tibial epiphysis

etiology

The exact cause of this sporadic malposition is not known. Hyperextended legs in the womb, fibrosis of the quadriceps femoris muscle or lack of cruciate ligaments are possible options. Since muscle fibrosis is found in all patients, this is the likely cause.

There is an association with:

Diagnosis

Due to the misalignment, the disease is already evident at birth.

An x-ray can document additional bony changes, and an ultrasound examination can also show the position of the not yet ossified patella . The differential diagnostic demarcation from the genu recurvatum (with joint surfaces that are literally one on top of the other) can be sonographically, the detection of the cruciate ligaments - if necessary for the treatment - can be done by MRI or sonographically.

treatment

The treatment should take place as soon as possible at a pediatric orthopedic center with stretching of the shortened thigh muscle under anesthesia and a compression cast. The ultrasound is well suited during Repositionsversuches and for follow-up.

If reduction cannot be achieved in this way, surgical quadriceps lengthening is possible.

The treatment result depends on the extent of the reduction achieved on accompanying changes in the capsular apparatus, in particular on the placement of the cruciate ligaments. As a rule, there remains a limited ability to bend to 90 ° -100 °.

literature

Individual evidence

  1. ↑ A.Chatelain: Observation d'une luxation congenital arrière du tibia en , 1822: Bibliothèque Médicale ou Recueil Périodique D'Extraits of the Meilleurs Ouvrages de Médecine et de Chirurgie 75, page 103-105
  2. ↑ K. Jacobsen, F. Vopalecky: Congenital dislocation of the knee. In: Acta orthopaedica Scandinavica. Volume 56, Number 1, February 1985, pp. 1-7, ISSN  0001-6470 . PMID 3984696 .
  3. ↑ RW PROVENZANO: Congenital dislocation of the knee; report of a case. In: The New England Journal of Medicine . Volume 236, Number 10, March 1947, pp. 360-362, ISSN  0028-4793 . doi: 10.1056 / NEJM194703062361003 . PMID 20288382 .
  4. ^ BH Curtis, RL Fisher: Congenital hyperextension with anterior subluxation of the knee. Surgical treatment and long-term observations. In: The Journal of bone and joint surgery. American volume. Volume 51, Number 2, March 1969, pp. 255-269, ISSN  0021-9355 . PMID 5767318 .
  5. ^ DS Middleton: The pathology of genu recurvatum. 1935, in: British Journal of Surg 22, p. 696
  6. ↑ K. Parsch: Sonography of the congenital knee dislocation. In: The orthopedist. Volume 31, Number 3, March 2002, pp. 306-307, ISSN  0085-4530 . PMID 12017861 .
  7. ↑ K. Parsch, RD Schulz R: Ultrasonography in congenital dislocation of the knee. 1994, in: Journal of Pediatric Orthopedics (B) 3. Pages 76-81