Conservative management of the bilateral congenital dislocation of the knee: A case report

Abstract

Objectives: To raise the awareness of colleagues and other medical professionals to this uncommon condition and to improve the knowledge of medical personnel in the conservative management of congenital dislocation of the knee. Method: Information was retrospectively obtained from the hospital docket, actively from interviews with the mother of the child and clinical follow-up of the patient, to derive the requisite information. Clinical and radiographic photographs of the patient's condition were also obtained from her initial presentation. The mother of the child was required to sign a consent form after a comprehensive explanation of the nature and purpose of the proposed article (see attached document.) Ethical approval was sought and granted by the UHWI/UWI/FMS Ethics Committee, Mona (see attached document.) Results: The patient had serial casting performed on both lower limbs with weekly changes of the casts. There was a resolution of the anterior thigh creases and after three weeks of casting, the index case demonstrated full active pain free flexion of both knees. At 18 months follow-up, she demonstrated unassisted ambulation with normal range of motion of the knees and without any difficulties. Conclusion: Early diagnosis of the congenital dislocation of the knee (CDK) is very important. Non-operative treatment usually provides more stable and greater range of motion, and much more quadriceps strength than the surgical options. The index case had idiopathic CDK as no factors were identified to determine the cause of her condition. Flexible knees were demonstrated and therefore this case would be classified as a grade II CDK based on the Tarek grading system. This implies that serial casting should be attempted.