V Rampal1, M Mehrafshan2, M Ramanoudjame3, R Seringe4, C Glorion5, P Wicart6. 1. Service d'orthopédie pédiatrique, hôpital Saint-Vincent-de-Paul, AP-HP, 82, avenue Denfert-Rochereau, 75014 Paris, France; Service d'orthopédie pédiatrique, hôpitaux pédiatriques de Nice, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France. Electronic address: rocher-rampal.v@pediatrie-chulenval-nice.fr. 2. Service d'orthopédie pédiatrique, hôpital Saint-Vincent-de-Paul, AP-HP, 82, avenue Denfert-Rochereau, 75014 Paris, France; Service de chirurgie pédiatrique, children's medical center, pediatrics center of excellence, Tehran university of medical sciences, Mohammad Gharib street, Tehran, Iran. 3. Service d'orthopédie pédiatrique, hôpital Saint-Vincent-de-Paul, AP-HP, 82, avenue Denfert-Rochereau, 75014 Paris, France. 4. Service d'orthopédie pédiatrique, hôpital Saint-Vincent-de-Paul, AP-HP, 82, avenue Denfert-Rochereau, 75014 Paris, France; Service d'orthopédie, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. 5. Service d'orthopédie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France. 6. Service d'orthopédie pédiatrique, hôpital Saint-Vincent-de-Paul, AP-HP, 82, avenue Denfert-Rochereau, 75014 Paris, France; Service d'orthopédie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
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.
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.