Orthopedics - Oleksa A.P. 2006

Congenital and acquired deformities of the lower limb
Congenital deformities of the lower leg
Congenital dislocation of the knee

pCongenital dislocations of the knee Tibia are extremely rare, and according to Drehman and Kefer N. 1927, they occur 30 or more times less frequently than congenital hip dislocations. Moreover, they can be unilateral or bilateral and are three times more common in boys according to Sporri, 31 Fig. 185.p pAs a rule, knee hyperextension genu recurvatum leads to anterior dislocations of the tibia Fig. 186.p p Class=centerimg height=289 src=oleksa.filesimage190.jpg width=417p p class=centerFig. 184. Congenital torsion of both tibiae a, three years after spontaneous correction b.p p class=centerimg height=275 src=oleksa.filesimage191.jpg width=256p p class=centerFig. 185. Lateral radiographs of both knee joints in bilateral congenital subluxation of the tibiae.p pTheir cause was previously attributed to congenital dystrophy of the quadriceps Muscle, which becomes tight and prevents flexion of the tibia Potel K.. Currently, it is believed that the cause of tibial dislocation is intrauterine malposition of the fetus, where the knees are extended while the hips are flexed Unger H., 1959.p p class=centerimg height=394 src=oleksa.filesimage192.jpg width=192p p class=centerFig. 186. Anterior Congenital Dislocation of the tibia.p pAccording to Drehman, three stages of dislocation development are distinguishedp pStage one: the articular surface of the tibia displaces anteriorly relative to the Femur, and its upper margin enters the contact zone between the femoral condyles and the Patella.p pStage two: during flexion of the tibia, its posterior margin rests against the anterior part of the articular surface of the femoral condyles.p pStage three: Displacement of the articular end of the tibia under weightbearing occurs not only anteriorly but also slightly upward.p pThus, this Classification reflects the dynamics of transition from a hyperextended knee to subluxation and, subsequently, to dislocation of the tibia.p pOn examination of the child, a hyperextended knee is clearly visible with taut Skin in the popliteal region, where the backwardprotruding femoral condyles can be palpated as steps. Anteriorly, the skin over the knee is loose and forms a transverse fold beneath the patella. Due to knee hyperextension, the tendons of the knee flexors are displaced anteriorly and act as extensors, which increases the anterior displacement of the tibia. Depending on the stage of dislocation, the hyperextended knee can be flexed by only 15°–30°. This contracture, combined with genu recurvatum, leads to limb shortening and severely impairs its function.p pOn a lateral radiograph of young children whose cartilaginous epiphyses are not yet visible, displacement of the tibial axis can be detected, while in older children, this displacement is even more pronounced Fig. 185.p pClinical Diagnosis presents no difficulties; therefore, Treatment should begin within the first weeks of the child's life. Treatment consists of reducing the subluxation or dislocation of the tibia and immobilizing the limb with a posterior plaster splint in the achieved position of flexion.p pManual reduction should be performed carefully to avoid causing epiphyseolysis, by gradual flexion of the tibia while supporting the femur from behind. If necessary, this manipulation should be repeated. The plaster splint is removed after 3–4 weeks, followed by passive physical therapy.p pIf manual reduction of the tibia fails, Schade traction is applied, after which the tibia is flexed to a 90° angle and the limb is immobilized with a plaster splint.p pIn older untreated children, contracture of the quadriceps muscle develops, and the anteriorly displaced tendons of the knee flexors make reduction of the tibia impossible, even with The Use of muscle relaxants.p pIn such cases, Surgical treatment is indicated. The operation is performed under general anesthesia. To lengthen the contracted quadriceps femoris muscle, a tenotomy of the rectus femoris is performed, along with tenotomy of the flexors if necessary and capsulotomy.p pHowever, it should be noted that recurrences of subluxation and even dislocation of the tibia can occur after conservative treatment and tenotomy. To prevent this, Kozlovsky A.A. 1936 performed knee arthrodesis, while Bogdanov F.R. combined joint resection with segmental resection of the femur and fixation of the bone fragments with a metal rod.p pIn some cases of reducible dislocations, he performed reconstruction of the cruciate ligaments during open reduction of the tibia.p pClinicians point out that only early treatment is most effective, although the desired results are not always achieved. It is crucial to diagnose the condition immediately after birth and initiate conservative treatment, which yields positive functional outcomes in most cases.p pWe emphasize once again that manual reduction of the dislocated tibia must be performed with extreme caution to avoid causing epiphyseolysis or bone fracture. Whenever possible, it is preferable to perform the reduction gradually, in stages.p

After the first year of an untreated child's life, the abnormal anatomical relationship between the femur and tibia becomes so fixed that achieving a good outcome without complications is impossible, as changes have already occurred in the musculo-articular system.



Last update: 10/08/2026

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