Neglected congenital bilateral knee dislocation treated by quadricepsplasty with semitendinosus and sartorius transfer: A case report

Abstract

BACKGROUND

Congenital knee dislocation (CKD) is a rare condition, which accounts for 1% of congenital hip dislocations. It can present as an isolated condition or coexist with other genetic disorders. Treatment options include serial casting, percutaneous quadriceps recession, and V-Y quadricepsplasty (VYQ). The pathogenesis and hereditary patterns of CKD are not fully understood, with most cases being familial. CKD is usually managed immediately after birth. However, in this report, the patient was neglected for 2 years.

CASE SUMMARY

A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting; the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status. Her birth was noted for a breech presentation accompanied by oligohydramnios. The delivery took a long time, requiring immediate medical interventions. As an infant, she had chronic diseases, including a small patent ductus arteriole, multicystic dysplastic kidney disease, and epilepsy. She was found to have a bilateral knee dislocation of approximately -90° on hyperextension. A multidisciplinary team was involved, and medical care was optimized. She underwent VYQ plus semitendinosus and sartorius transfer. After four postoperative follow-ups, her knees were regaining mobility, and she could walk for 2-3 steps without assistance.

CONCLUSION

This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.

Keywords: Knee dislocation; Congenital knee dislocation; V-Y quadricepsplasty; Neglect; Neglected knee dislocation; Pediatric orthopedics; Case report

Core Tip: Congenital knee dislocation is a rare condition, which accounts for 1% of congenital hip dislocations. According to a previous study, patients must be managed after birth immediately or up to 3 months. However, in the present case, the patient’s condition was neglected for 2 years for many reasons. Although in the literature V-Y quadricepsplasty (VYQ) was performed, in our surgical approach, VYQ plus semitendinosus and sartorius transfer were performed to fill the gap and increase muscle power. The outcome was satisfactory at 6 months follow up.