Congenital Dislocation of the Knee at Birth – Part 2: Impact of a New Classification on Treatment Strategies, Results and Prognostic Factors Publisher Pubmed



Rampal V^{1, 5} ; Mehrafshan M^{1, 2} ; Ramanoudjame M¹ ; Seringe R^{1, 3} ; Glorion C⁴ ; Wicart P^{1, 4}
Source: Orthopaedics and Traumatology: Surgery and Research Published:2016

Abstract

Introduction An original classification of congenital dislocation of the knee (CDK) was drawn up, based on neonatal semiology. The objective of the present study was to assess impact on treatment decision-making and prognosis. Material and methods Fifty-one CDKs in 40 patients were classified neonatally into 3 types: I, reducible (n = 28); II, recalcitrant (n = 16); and III, irreducible (n = 7). Number of anterior skin grooves, range of motion (RoM), flexion deficit and reduction stability were recorded. Depending on reducibility, treatment comprised: physiotherapy with splints, traction with cast immobilization, or surgery. At follow-up, knees were assessed in terms of RoM and stability. Results Mean age at first consultation was 5.6 days (range: 0–30). Mean age at follow-up was 9 years (range: 1–26). Physiotherapy with splinting achieved stable reduction in all type-I knees. Five type-II knees (31%) required traction, none of which needed surgery. Four type-III knees (57%) required surgery. Outcome was good or excellent in 82% of type-I knees, good in 68% of type II and poor in all type-III knees. Conclusion The study confirmed the relevance of the present neonatal classification to treatment, with increasing rates of surgical indication and decreasing rates of satisfactory outcome from types I to III. Therapeutic attitude can be graded according to severity of CDK. Level of evidence IV, single-center retrospective series. © 2016 Elsevier Masson SAS