Congenital dislocation of the knee: A noninvasive treatment method

Cover Page

Cite item

Full Text

Abstract

BACKGROUND: Congenital knee dislocation is a significant topic of interest in the possible application of new reduction techniques immediately after birth. This initiative aims to minimize the consequences of dislocation, ensuring the possibility of normal joint formation and functioning from the very first stages of life. This is not only a technical achievement but also an approach to providing optimal conditions for the health and development of children with congenital knee dislocation.

AIM: This study aimed to evaluate the functional and long-term treatment outcomes of congenital knee dislocation using a new patented method.

MATERIALS AND METHODS: A total of 120 patients (194 knees) with congenital knee dislocation were examined. The patients were divided into the main group (55 patients, 90 knee joints) and the control group (65 patients, 104 knee joints). The main group received the treatment developed by the authors using an Ergopower ER 7028 vibration massager. In the control group, the traditional method of orthopedic correction of congenital knee dislocation using a Von Rosen splint and circular plaster casts was employed. At the start of treatment, the age of the patients in the main group was Me 28 [Q1 28; Q3 30] hours and that of the control group was Me 30 [Q1 28; Q3 34.5] hours.

RESULTS: A comparative analysis of the treatment outcomes of the main and control groups showed that the developed method for correcting congenital knee dislocation using a vibration massager and careful manipulations, in contrast to traditional technology, achieved the most accurate orthopedic correction in 95% of cases, ensured the restoration of the axial profile of the knee joint and its stability, and created conditions for the harmonious growth and development of the lower extremities in adulthood. In the main group, after conservative treatment of congenital knee dislocation using improved technology, indicators for assessing knee joint function (66.7%) and pain relief (98.2%) were excellent after 5 years of observation, which was confirmed by data from a clinical study and use of specialized questionnaires.

CONCLUSIONS: The proposed innovative method of conservative orthopedic correction of congenital knee dislocation by vibrovascularization of the thigh muscles is a differentiated approach to conservative treatment, which improved the overall and long-term treatment outcomes.

About the authors

Igor Yu. Kruglov

V.A. Almazov National Medical Research Center

Author for correspondence.
Email: dr.gkruglov@gmail.com
ORCID iD: 0000-0003-1234-1390
SPIN-code: 7777-1047
Russian Federation, Saint Petersburg

Nicolai Yu. Rumyantsev

V.A. Almazov National Medical Research Center

Email: dr.rumyantsev@gmail.com
ORCID iD: 0000-0002-4956-6211
Russian Federation, Saint Petersburg

Gamzat G. Omarov

North-Western State Medical University named after I.I. Mechnikov

Email: ortobaby@yandex.ru
ORCID iD: 0000-0002-9252-8130
SPIN-code: 9565-8513

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Sergey S. Smirnov

V.A. Almazov National Medical Research Center; Vreden National Medical Center for Traumatology and Orthopedics

Email: smirnovss_md@mail.ru
ORCID iD: 0000-0002-3210-9962
SPIN-code: 4352-9475
Russian Federation, Saint Petersburg; Saint Petersburg

Ilya M. Kagantsov

V.A. Almazov National Medical Research Center; North-Western State Medical University named after I.I. Mechnikov

Email: ilkagan@rambler.ru
ORCID iD: 0000-0002-3957-1615
SPIN-code: 7936-8722

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

References

  1. Mehrafshan M, Wicart P, Ramanoudjame M, et al. Congenital dislocation of the knee at birth — Part I: Clinical signs and classification. Orthop Traumatol Surg Res. 2016;102(5):631–633. doi: 10.1016/j.otsr.2016.04.008
  2. Klein C, Bulaid Y, Deroussen F, et al. Congenital dislocation of the knee in a three-year-old-child with Larsen syndrome: Treatment with a hexapod-type external fixator. Knee. 2018;25(5):966–971. doi: 10.1016/j.knee.2018.07.006
  3. Kruglov IY, Agranovich OE, Rumyantsev NY, et al. Congenital dislocation of the knee: a morphological study. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2020;8(4):427–435. EDN: CBRFDQ doi: 10.17816/PTORS25809
  4. Kruglov IY, Rumyantsev NY, Rumyantseva NN, et al. Some morphological prerequisites for the use of vibration massage in the treatment of congenital dislocation of the knee. Medline.ru. 2023;24(2):1160–1171. EDN: CIYMCY
  5. Patent RU 2789202 C1 /31.01.2023. Kruglov IY, Rumyantsev NY, Kagantsov IM, et al. Method of treatment of congenital anterior dislocation of the tibia of idiopathic character of moderate and severe degree in newborns and infants. (In Russ.)
  6. Kruglov IY, Rumyantsev NY, Agranovich OE, et al. Current views on the management of congenital dislocation of the knee based on current data on the outcomes of orthopedic treatment in these patients. N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):93–100. EDN: UUIQCE doi: 10.17816/vto71231
  7. Ferris B, Aichroth P. The treatment of congenital knee dislocation. Clin Orthop Relat Res. 1987;216:135–140. doi: 10.1097/00003086-198703000-00021
  8. Bortulev PI. Optimisation of surgical treatment of children with dysplastic hip subluxation [dissertation]. Saint Petersburg, 2020. 112 p. (In Russ.)
  9. Abdelaziz TH, Samir S. Congenital dislocation of the knee: a protocol for management based on degree of knee flexion. J Child’s Orthop. 2011;5(2):143–149. doi: 10.1007/s11832-011-0333-7
  10. Kruglov IY, Rumyantsev NY, Baindurashvili AG, et al. Comparison of the clinical and radiological pictures in patients with congenital knee dislocation during treatment. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2023;11(1):39–48. EDN: KXFJCD doi: 10.17816/PTORS111181
  11. Hung NN, Tan D, Do Ngoc Hien N. Patellar dislocation due to iatrogenic quadriceps fibrosis: results of operative treatment in 54 cases. J Child Orthop. 2014;8(1):49–59. doi: 10.1007/s11832-014-0564-5
  12. Kaissi AA, Ganger R, Klaushofer K, Grill F. The management of knee dislocation in a child with Larsen syndrome. Clinics (Sao Paulo). 2011;66(7):1295–1299. doi: 10.1590/s1807-59322011000700030
  13. Flowers D, Olmedo M. Non-surgical management of a tibiofemoral knee dislocation in a patient with sarcoidosis. BMJ Case Rep. 2019;12(11):e229605. doi: 10.1136/bcr-2019-229605
  14. Morales-Roselló J, Loscalzo G, Hueso-Villanueva M, et al. Congenital knee dislocation, case report and review of the literature. J Matern Fetal Neonatal Med. 2022;35(4):809–811. doi: 10.1080/14767058.2020.1731464
  15. Shah NR, Limpaphayom N, Dobbs MB. A minimally invasive treatment protocol for the congenital dislocation of the knee. J Pediatr Orthop. 2009;29(7):720–725. doi: 10.1097/BPO.0b013e3181b7694d
  16. Youssef AO. Limited open quadriceps release for treatment of congenital dislocation of the knee. J Pediatr Orthop. 2017;37(3):192–198. doi: 10.1097/BPO.0000000000000612
  17. Patwardhan S, Shah K, Shyam A, Sancheti P. Assessment of clinical outcome of percutaneous needle quadriceps tenotomy in the treatment of congenital knee dislocation. Int Orthop. 2015;39(8):1587–1592. doi: 10.1007/s00264-015-2806-7
  18. Carlson HD, O’Connor J. Congenital dislocation of the knee. Am J Roentgenol. 1976;127(3):465–468. doi: 10.2214/ajr.127.3.465
  19. Charif P, Reichelderfer TE. Genu recurvatum congenitum in the newborn. Clin Pediatr. 1965;4(10):587–594. doi: 10.1177/000992286500401006
  20. Nogi J, Mac Ewen D. Congenital dislocation of the knee. J Pediatr Orthop. 1982;2(5):509–513. doi: 10.1097/01241398-198212000-00009
  21. Rumyantsev NY, Kruglov IY, Omarov GG, et al. Congenital dislocation of the knee: prenatal diagnostics and treatment at an early age. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(2):26–35. EDN: YSTYIL doi: 10/17816/PTORS5226-35
  22. Rampal V, Mehrafshan M, Ramanoudjame M, et al. Congenital dislocation of the knee at birth — Part 2: Impact of a new classification on treatment strategies, results and prognostic factors. Orthop Traumatol Surg Res. 2016;102(5):635–638. doi: 10.1016/j.otsr.2016.04.009

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Congenital dislocation of the left knee and patient’s appearance

Download (197KB)
Indexing metadata
3. Fig. 2. Treatment of a patient with congenital dislocation of the right knee using the method developed by the authors

Download (180KB)
Indexing metadata
4. Fig. 3. Treatment outcome scale. I — correct position of the bones and knee joint flexion >120°; II — correct alignment of the bones and knee joint flexion from 90° to 120°; III — correct alignment of the bones and knee joint flexion from 50° to 90°; IVA — correct alignment of the bones and knee joint flexion from 0° to 50°; IVB — knee joint flexion up to 90° with persistent anterior subluxation of the tibia

Download (93KB)
Indexing metadata
5. Fig. 4. Comparison of the degree of passive flexion of the tibia immediately after treatment in the main and control groups. n — is the affected limb

Download (106KB)
Indexing metadata
6. Fig. 5. Results of assessing knee joint function in the main and control groups 5 years after treatment for CDK. n — is the affected limb

Download (94KB)
Indexing metadata
7. Fig. 6. Treatment outcomes of congenital bilateral knee dislocation according to the method developed by the authors: a — front view of the patient; b — rear view of the patient; c — side view of the patient; d — side view of the patient with maximum flexion of the tibia

Download (546KB)
Indexing metadata

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies