Comparison of the clinical and radiological pictures in patients with congenital knee dislocation during treatment

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Abstract

BACKGROUND: Congenital knee dislocation is a very rare musculoskeletal disease, and it occurs in approximately 1 per 100,000 live births. Many researchers note that the treatment of congenital knee dislocation should begin with conservative methods, during which various complications arise.

AIM: This study aimed to compare the clinical and radiological classifications of congenital knee dislocation and show the results of the treatment of this deformation using a Von Rosen splint and plaster corrections.

MATERIALS AND METHODS: The study included 58 patients (34 boys and 24 girls) with congenital knee dislocation (83 knee joints). Congenital knee dislocation with arthrogryposis and other systemic pathologies were not included in the study. Before treatment, all patients were assessed for the severity of congenital knee dislocation according to the Tarek and J. Leveuf system. To evaluate the obtained results, nonparametric statistics were used. To search for differences between groups, the Kruskal–Wallis test and the median test were used. To search for correlations, Spearman coefficients were used. Statistica v10 was used for statistical analysis.

RESULTS: Clinical and radiological data were compared. In both groups, after conservative treatment, excellent and good results were obtained in nearly 98% and satisfactory in 2%. After conservative therapy, surgical treatment was required in 2 of 37 knee joints with the initial severity of Tarek III deformity.

CONCLUSIONS: The severity of the deformity according to the Tarek system makes it possible to predict the effectiveness of the conservative treatment of congenital knee dislocation at a statistically significant level.

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About the authors

Igor Yu. Kruglov

Almazov National Medical Research Centre

Email: dr.gkruglov@gmail.com
ORCID iD: 0000-0003-1234-1390
SPIN-code: 7777-1047
Scopus Author ID: 57193279395

MD, Paediatric Orthopaedic Surgeon

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

Alexey G. Baindurashvili

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: turner011@mail.ru
ORCID iD: 0000-0001-8123-6944
SPIN-code: 2153-9050
Scopus Author ID: 6603212551

MD, PhD, Dr. Sci. (Med.), Professor, Member of RAS, Honored Doctor of the Russian Federation

Russian Federation, Saint Petersburg; Saint Petersburg

Gamzat G. Omarov

H. Turner National Medical Research Centre for Children’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

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

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg; Saint Petersburg

Natalia N. Rumiantceva

Almazov National Medical Research Centre

Email: natachazlaya@mail.ru
ORCID iD: 0000-0002-2052-451X
SPIN-code: 3497-3878

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
SPIN-code: 7608-8718

MD, PhD, Cand. Sci. (Med.)

 
Russian Federation, Saint Petersburg

Olga M. Vorobeva

Almazov National Medical Research Centre

Email: olgarasp@yandex.ru
ORCID iD: 0000-0002-1349-7349
SPIN-code: 3327-7617
Scopus Author ID: 57205331117
ResearcherId: AAZ-5818-2020

MD, Pathologist

Russian Federation, Saint Petersburg

Tatiana M. Pervunina

Almazov National Medical Research Centre

Email: ptm.pervunina@yandex.ru
ORCID iD: 0000-0001-9948-7303
SPIN-code: 3288-4986
Scopus Author ID: 56572907100

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Ilya M. Kagantsov

Almazov National Medical Research Centre; North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: ilkagan@rambler.ru
ORCID iD: 0000-0002-3957-1615
SPIN-code: 7936-8722
Scopus Author ID: 55358760000

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg; Saint Petersburg

References

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Congenital knee dislocation severity according to the Leveuf classification [1]: a, grade I (recurvation); b, grade II (subluxation); c, grade III (dislocation)

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3. Fig. 2. Radiogram of the knee joint of patient R., age 2 weeks. Knee joint subluxation (grade II according to the Leveuf system). Hyperextension in the knee joint 43°

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4. Fig. 3. Distribution of knee joints according to the severity of congenital knee dislocation as assessed by the Tarek system (n = 83)

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5. Fig. 4. Distribution of the knee joints depending on the severity of deformity according to the Leveuf system [7] and treatment method (n = 83)

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6. Fig. 5. Scale for evaluating treatment results proposed by the authors: I, correct position of the bones and flexion at the knee joint >120°; II, correct position of the bones and flexion at the knee joint of 90–120°; III, correct position of the bones and flexion at the knee joint of 50–90°; IVA, correct position of the bones and flexion at the knee joint from 0 to 50°; IVB, flexion at the knee joint up to 90° with persistent anterior subluxation of the tibia

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7. Fig. 6. Results of conservative treatment of congenital knee dislocation, depending on the treatment method: 1, plaster correction; 2, von Rosen splint

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8. Fig. 7. Knee joint flexion as a result of treatment, depending on the initial assessment according to the Tarek (a) and J. Leveuf (b) systems: 1, plaster correction; 2, von Rosen splint

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9. Fig. 8. Differences in the passive flexion of the knee joint depending on the initial Tarek score

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10. Fig. 9. Differences in passive flexion of the knee joint after treatment in patients, depending on the initial assessment according to the Leveuf system [7]

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11. Fig. 10. Possible complications in the treatment of congenital knee dislocation: a, photo of patient N., 1 month old, skin maceration under a plaster cast in the area of compression; b, radiograph of the knee joint of patient A., 4 months old, epiphysiolysis of the proximal end of the tibia; c, appearance of the same patient

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Copyright (c) 2023 Kruglov I., Rumyantsev N., Baindurashvili A.G., Omarov G.G., Rumiantceva N.N., Razmologova O.Y., Vorobeva O.M., Pervunina T.M., Kagantsov I.M.


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