Introduction |
- Spectrum of disease including
- positional contractures
- rigid dislocation
- Structural components include
- quadricep tendon contracture
- anterior subluxation of hamstring tendon
- absent suprapatellar pouch
- tight collateral ligament
- Often occurs in children with
- myelomeningocele
- arthrogryposis
- Larsen's syndrome
- Associated conditions
- developmental dysplasia of the hip
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- 50% will have hip dysplasia affect one or both hips
- clubfoot,
- metatarsus adductus
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Classification
- Tarek CDK Classification
- Graded by passive range of flexion and radiologic appearance
- Can guide treatment
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Presentation |
- Presents with hyperextened knee at birth
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Treatment |
- Nonoperative treatment
- reduction with manual manipulation and casting
- indications
- Tarek GI, initial treatment for GII (up to 1 month of age)
- most cases can be treated nonoperatively
- if both knee and hip dislocated, then treat knee first
- can't get Pavlik harness on hip if knee dislocated
- technique
- long leg casting on weekly basis
- Operative treatment
- surgical soft tissue release
- indications
- failure to gain 30° of flexion after 3 months of casting
- Tarek GII (identified after 1 month of age), GIII, and in recurrent cases
- goal of surgery is to obtain 90° of flexion
- percutaneous quadriceps recession (PQR)
- quadriceps tendon lengthening (V-Y quadricepsplasty or Z lengthening)
- anterior joint capsule release
- hamstring tendon posterior transposition
- collateral ligaments mobilization
- postoperative
- cast in 45 to 60° flexion for 3 to 4 weeks
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