Percutaneous needle quadriceps tenotomy for treatment of idiopathic congenital dislocation of the knee

Background: Congenital dislocation of the knee is a rare condition with an incidence of 1:100000 and can be idiopathic or syndromic. Our study evaluated percutaneous needle tenotomy for treatment of idiopathic flexible congenital dislocation of the knee. Methods: A prospective case series was done on 15 infants with idiopathic congenital dislocation of the knee: nine boys and six girls. Closed reduction was first attempted, and if it failed the knee was examined. If the knee could be flexed beyond 0, serial casting was done. If the knee could not be flexed beyond 0, percutaneous needle tenotomy was done. Results: Fifteen infants presented with idiopathic flexible congenital dislocation of the knee. Three dislocations were reduced closed, five were reduced with serial casting with gradual flexion, and seven that could not be flexed beyond 0 underwent percutaneous needle tenotomy. All patients could walk within the normal age range with no pain. All had full range of motion and good quadriceps function. Ultrasound was done in patients who had percutaneous needle tenotomy at walking age to ensure healing of the quadriceps tendon, which was adequately healed in all patients. Conclusions: Percutaneous needle tenotomy is a good option for treatment of congenital dislocation of the knee. Careful selection of patients is mandatory.