Abstract：
BACKGROUND: Congenital dislocation of the knee (CDK) may be idiopathic or associated with another condition, such as Larsen syndrome or arthrogryposis. Surgical reduction of type-3 dislocation may require quadricepsplasty (QP) or femoral diaphyseal shortening (FS). Because it is unknown which treatment is more effective, we evaluated long-term outcomes using patient-reported questionnaires and gait analysis, comparing results by surgery type and underlying diagnosis.
METHODS: Twelve patients (mean age, 19 mo) were treated surgically for CDK from 1985 to 2015 and studied 9 to 30 years postoperatively. Three participants had idiopathic CDK, 5 had Larsen syndrome, and 4 had arthrogryposis. Eleven knees underwent QP and 7 underwent FS. Participants were evaluated in our movement science laboratory and completed patient-reported outcome questionnaires. Data were compared with healthy, age-matched control values at the same visit.
RESULTS: Surgically treated knees had less flexion during swing ( P <0.01), less overall motion ( P <0.01), greater coronal instability ( P <0.04), and slower gait ( P <0.01) compared with controls. QP knees had more instability in midstance ( P =0.03) and less flexion during gait compared with FS knees, less sagittal power generation than controls ( P <0.01), and trended toward lower scores on Knee Injury and Osteoarthritis Outcome and Lysholm Knee Questionnaires than FS patients did. The idiopathic group had the gait most similar to that of controls, followed by the Larsen syndrome group and then the arthrogryposis group. The idiopathic group also had a better UCLA Activity Score ( P =0.03) than the arthrogryposis group did.
CONCLUSIONS: Surgical treatment of type-3 CDK will not likely restore normal knee function, suggesting teratologic joint abnormality. In this small series, FS produced better gait mechanics and patient-reported outcomes compared with QP. Not surprisingly, patients with idiopathic CDK had better outcomes than those with a syndromic diagnosis, likely related to having only a single joint affected.
METHODS: Level III.
METHODS: Twelve patients (mean age, 19 mo) were treated surgically for CDK from 1985 to 2015 and studied 9 to 30 years postoperatively. Three participants had idiopathic CDK, 5 had Larsen syndrome, and 4 had arthrogryposis. Eleven knees underwent QP and 7 underwent FS. Participants were evaluated in our movement science laboratory and completed patient-reported outcome questionnaires. Data were compared with healthy, age-matched control values at the same visit.
RESULTS: Surgically treated knees had less flexion during swing ( P <0.01), less overall motion ( P <0.01), greater coronal instability ( P <0.04), and slower gait ( P <0.01) compared with controls. QP knees had more instability in midstance ( P =0.03) and less flexion during gait compared with FS knees, less sagittal power generation than controls ( P <0.01), and trended toward lower scores on Knee Injury and Osteoarthritis Outcome and Lysholm Knee Questionnaires than FS patients did. The idiopathic group had the gait most similar to that of controls, followed by the Larsen syndrome group and then the arthrogryposis group. The idiopathic group also had a better UCLA Activity Score ( P =0.03) than the arthrogryposis group did.
CONCLUSIONS: Surgical treatment of type-3 CDK will not likely restore normal knee function, suggesting teratologic joint abnormality. In this small series, FS produced better gait mechanics and patient-reported outcomes compared with QP. Not surprisingly, patients with idiopathic CDK had better outcomes than those with a syndromic diagnosis, likely related to having only a single joint affected.
METHODS: Level III.
摘要：
背景：先天性膝关节脱位（CDK）可能是特发性或与其他疾病有关，如Larsen综合征或关节病。3型脱位的手术复位可能需要四端骨裂（QP）或股骨干缩短（FS）。因为不知道哪种治疗更有效，我们使用患者报告的问卷和步态分析评估了长期结果，按手术类型和基础诊断比较结果。
方法：12名患者(平均年龄，从1985年至2015年，对19个月）进行了CDK手术治疗，并在术后9至30年进行了研究。三名参与者患有特发性CDK，5人患有拉森综合征，4人患有关节病。11个膝盖接受了QP，7个膝盖接受了FS。参与者在我们的运动科学实验室进行了评估，并完成了患者报告的结果问卷。数据与健康的，同一次就诊时年龄匹配的控制值。
结果：手术治疗的膝盖在摆动时屈曲较少（P<0.01），整体运动较少(P<0.01)，日冕不稳定性更大(P<0.04)，与对照组相比，步态较慢（P<0.01）。与FS膝盖相比，QP膝盖在步态中更不稳定（P=0.03）和更少的屈曲。矢状发电量低于对照组(P<0.01)，与FS患者相比，膝关节损伤和骨关节炎结局和Lysholm膝关节问卷的得分趋于较低。特发性组的步态与对照组最相似，其次是Larsen综合征组，然后是关节病组。特发性组的UCLA活动评分（P=0.03）也优于关节炎组。
结论：手术治疗3型CDK不可能恢复正常膝关节功能，提示畸形关节异常。在这个小系列中,与QP相比，FS产生了更好的步态力学和患者报告的结果。毫不奇怪,特发性CDK患者的预后优于有综合征诊断的患者，可能与只有一个关节受到影响有关。
方法：三级。
方法：12名患者(平均年龄，从1985年至2015年，对19个月）进行了CDK手术治疗，并在术后9至30年进行了研究。三名参与者患有特发性CDK，5人患有拉森综合征，4人患有关节病。11个膝盖接受了QP，7个膝盖接受了FS。参与者在我们的运动科学实验室进行了评估，并完成了患者报告的结果问卷。数据与健康的，同一次就诊时年龄匹配的控制值。
结果：手术治疗的膝盖在摆动时屈曲较少（P<0.01），整体运动较少(P<0.01)，日冕不稳定性更大(P<0.04)，与对照组相比，步态较慢（P<0.01）。与FS膝盖相比，QP膝盖在步态中更不稳定（P=0.03）和更少的屈曲。矢状发电量低于对照组(P<0.01)，与FS患者相比，膝关节损伤和骨关节炎结局和Lysholm膝关节问卷的得分趋于较低。特发性组的步态与对照组最相似，其次是Larsen综合征组，然后是关节病组。特发性组的UCLA活动评分（P=0.03）也优于关节炎组。
结论：手术治疗3型CDK不可能恢复正常膝关节功能，提示畸形关节异常。在这个小系列中,与QP相比，FS产生了更好的步态力学和患者报告的结果。毫不奇怪,特发性CDK患者的预后优于有综合征诊断的患者，可能与只有一个关节受到影响有关。
方法：三级。
