Congenital dislocation of the knee: a morphological study

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Abstract

Background. Congenital knee dislocation is a rare disease of the musculoskeletal system (1 in 100,000 live births). In the literature, few studies have described the anatomical changes characteristic of this pathology, which are only revealed during surgical treatment.

Aim. This study aimed to evaluate the pathomorphological features of the ligamentous–articular apparatus and thigh muscles with congenital knee dislocation on autopsy material.

Materials and methods. The study included two fetuses with bilateral congenital knee dislocation after spontaneous miscarriage at 18 and 20 weeks of gestation and one stillborn fetus with bilateral congenital knee dislocation at 29 weeks of gestation. The comparison group was composed of two fetuses after spontaneous miscarriages at 18 and 20 weeks of gestation and one stillborn fetus at 25 weeks of gestation without anomalies of the lower extremities.

Results. Various abnormalities and displacements of the anatomical structures, as well as degenerative dystrophic changes in the soft tissues during histological examination, were found. Pathomorphological changes in the control group were not detected.

Conclusion. Pathomorphological changes are the main manifestations of congenital knee dislocation in the studied fetuses.

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About the authors

Igor Yu. Kruglov

Almazov National Medical Research Centre

Author for correspondence.
Email: dr.gkruglov@gmail.com
ORCID iD: 0000-0003-1234-1390

MD, paediatric orthopaedic surgeon, junior researcher of Research Laboratory of Congenital and Hereditary Pathology Surgery

Russian Federation, Saint Petersburg

Olga E. Agranovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN-code: 4393-3694
http://www.rosturner.ru/kl10.htm

MD, PhD, D.Sc., Supervisor of the Department of Arthrogryposis

Russian Federation, Saint Petersburg

Nicolai Yu. Rumyantsev

Almazov National Medical Research Centre

Email: dr.rumyantsev@gmail.com
ORCID iD: 0000-0002-4956-6211

MD, Paediatric Orthopaedic Surgeon

Russian Federation, Saint- Petersburg

Olga Yu. Razmologova

Almazov National Medical Research Centre

Email: or1973@yandex.ru
ORCID iD: 0000-0001-7073-899X

MD, PhD, pathologist, Head of the Department of Pathological Anatomy Polenov Russian Neurosurgical Institute

Russian Federation, Saint Petersburg

Andrey V. Kolobov

St. Petersburg State University

Email: pathandrey@rambler.ru
ORCID iD: 0000-0003-3713-7484

MD, PhD, pathologist, Associate Professor, Department of Pathology, Faculty of Medicine

Russian Federation, Saint Petersburg

Gamzat G. Omarov

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery

Email: ortobaby@yandex.ru
ORCID iD: 0000-0002-9252-8130

MD, PhD, Research Associate

Russian Federation, Saint-Petersburg

Danil S. Kleshch

Children’s Regional Clinical Hospital

Email: danilklesh@mail.ru
ORCID iD: 0000-0002-4903-985X

MD, paediatric orthopaedic surgeon

Russian Federation, Krasnodar

Natalia N. Rumiantceva

Almazov National Medical Research Centre

Email: natachazlaya@mail.ru
ORCID iD: 0000-0002-2052-451X

MD, Paediatric Orthopaedic Surgeon, Junior Researcher of Research Laboratory of Congenital and Hereditary Pathology Surgery

Russian Federation, Saint- Petersburg

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2. Fig. 1. Anatomical features of extremity with congenital knee dislocation with grade II (gestational age — 20 weeks). a — normal position of the hamstrings; b — normal position of the hamstrings; c — flattening of the posterior intercondylar area as well as the posterior region of the superior tibial articular surface; d — flattening of the posterior region of the superior tibial articular surface; e — incomplete development of the patellofemoral articulation cavity; f — hypoplasia of the suprapatellar bursa (histotopogram, picro-Mallory staining, 50×)

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3. Fig. 2. Anatomical features of the extremity with congenital knee dislocation with grade III (gestational age — 29 weeks). a — anterior displacement of the hamstrings; b — normal diameter of the anterior cruciate ligament and its elongation along with the displacement of proximal patella; c — the absence of the patellofemoral articulation; aplasia of the suprapatellar bursa

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4. Fig. 3. Slides: degenerative–dystrophic changes in the muscles: a — normal muscular tissue (biopsy material from control group) (Van Gieson staining, 100×); b — edema and swelling of myocytes (1), partial disappearance of cross-striation (2), hypotrophy of myocytes (3) (Van Gieson staining, 400×); c — foci of myolysis (picro-Mallory staining, 100×); d — a large focus of fibrosis (picro-Mallory staining, 100×); e — the remaining muscle fibers in the focus of fibrosis (picro-Mallory staining, 100×); f — contracture degeneration of myocytes (Van Gieson staining, 100×)

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Copyright (c) 2021 Kruglov I.Y., Agranovich O.E., Rumyantsev N.Y., Razmologova O.Y., Kolobov A.V., Omarov G.G., Kleshch D.S., Rumiantceva N.N.

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