SURGICAL TREATMENT OF CONGENITAL KNEE SUBLUXATION DEFORMITY

Abstract

Introduction: In between 1995?1998 years seven knees of 6 patients who had congenital dislocation or subluxation of knee joint were operated in 1st Orthopaedics and Traumatology Clinic of Ankara Numune Hospital . The treatment results of 4 knees of 4 patients who had knee subluxation were evaluated in this study. Mean follow up is 20 months. Patients: Mean age of the children at the time of operation was 3.3 years. All of the patients are girls.All of the patiens in this study had congenital hip and foot deformities besides knee subluxation.
Method: The knees were operated according to the surgical technique described by Niebauer and King. During the operation we released the anterior capsule and the extansor retinaculum from patellar tendon to lateral and medial collateral ligaments Then the quadriceps tendon patella and patellar tendon were lengthened by Z plasty. The fibrous tissue in the suprapatellar region were also released. After the operation in order to keep the knee at 30°?45° flexion we applied a long leg cast. Four weeks after the operation we removed the cast and got rehabilitation program started.
Results: As the result of the treatment 2 patients could actively full extend their knees and could flex to 120°. One patient could actively extend her knee but full extension could not be obtained. She has 20° loss of active extension but passively the knee could be full extended. She could flex her knee to 100°. Last patient could actively full extend her knee and could flex to 40°. In this patient valgus deformity and tibial rotation were corrected during the operation.
Discussion: During the surgical treatment of congenital knee subluxation knee joint must be opened widely and all contracted tissues and fibrous bands must be released. Lengthening quadriceps tendon, patella and patellar tendon provides approximately 100° of knee motion The children who managed to follow quadriceps rehabilitation program achive knee extension.