Congenital dislocation of the knee at birth - Part 2: Impact of a new classification on treatment strategies, results and prognostic factors.
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.



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.



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.



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.



IV, single-center retrospective series.
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.
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Rampal
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.
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Mehrafshan
Service d'orthopédie pédiatrique, hôpital Saint-Vincent-de-Paul, AP-HP, 82, avenue Denfert-Rochereau, 75014 Paris, France.
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Ramanoudjame
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.
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Seringe
Service d'orthopédie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
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Glorion
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.
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Wicart
D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D031221:Knee Dislocation / Q000145:classification* / Q000151:congenital / Q000628:therapy*; D008297:Male; D026741:Physical Therapy Modalities; D011379:Prognosis; D012189:Retrospective Studies; D013165:Splints; D013710:Tendons / Q000601:surgery; D014143:Traction
Closed reduction; Congenital dislocation of the knee; Open reduction; Traction