Knee Conditions

Question 1

What condition is commonly a/w congenital dislocation of the knee?

Answer 1

DDH; up to 50%

Question 2

What is the initial treatment for congenital knee dislocation?

Answer 2

Serial casting 30 deg flex ion for 3 months

Question 3

What is the treatment for a painful bipartisan patella?

Answer 3

Conservative management for 6 months; if symptoms continue can excuse the fragment or do a lateral release (superolateral)

Question 4

What is the cause of popliteal cysts in children?

Answer 4

herniated posterior knee joint capsule synovium; usually found btw the medial head of gastroc and the semimembranosus

Question 5

What is the normal knee valgus in children?

Answer 5

3-4 years old can be up to 20 deg

Older than 7 years old should have less than 12 deg

Question 6

At what degree and age is hemiepiphysiodesis indicated in genu valgum?

Answer 6

Less than 10yo with >15-20 deg of valgus

Question 7

What is a risk factor for infantile Blounts disease?

Answer 7

overweight children that are early walkers (less than one year);
Also 
osteogenesis imperfecta
osteochondromas
trauma
various dysplasia

Question 8

What is the classification of infantile Blounts disease?

Answer 8

Langenskiold; type I-VI;

Types V and VI have a metaphyseal bar

Question 9

What angles are measured in Blounts disease?

Answer 9

Drennan- angle btw perpendicular axis of tibia and the metaphyseal beaks; >16 deg is abnormal and has 95% chance of progression
Less than 10 deg have 5% of progression

Tibiofemoral angle

Question 10

What is the treatment of infantile Blounts?

Answer 10

Less than 3yo types I and II get KFAO bracing for 2 years

Older than 3 yo or any Types III-VI treat with tib/fib osteotomy

Question 11

For treatment of infantile Blounts how much do you correct?

Answer 11

Over correct into 10-15 deg of valgus

Question 12

Which type of Blounts is usually unilateral?

Answer 12

Adolescent;

Infantile generally bilateral

Question 13

How does treatment of adolescent Blounts differ from infantile?

Answer 13

1) no role for bracing
2) do not over correct
3) may do osteotomy of femur if >8 deg valgus of distal femur