European Journal of Cardiovascular Medicine

Congenital dislocation of the knee (CDK) is a rare orthopedic condition present at birth, characterized by hyperextension of the knee joint with varying degrees of anterior displacement of the tibia relative to the femur [1]. The severity of the condition can range from mild hyperextension to a complete dislocation and is often associated with other musculoskeletal anomalies such as developmental dysplasia of the hip (DDH) and arthrogryposis [2]. The exact etiology of CDK remains unclear, but it is believed to result from intrauterine mechanical factors, genetic predisposition, or neuromuscular disorders [2].

Early diagnosis and timely intervention are crucial for optimal functional outcomes. Management strategies depend on the severity of the dislocation and include conservative approaches such as serial casting and stretching exercises for mild cases, while surgical intervention is required for severe or unresponsive cases [3]. A multidisciplinary approach involving pediatric orthopedic specialists, physiotherapists, and rehabilitation experts plays a vital role in the comprehensive care of affected infants [1,3].

A 30-year-old woman in her first pregnancy was noted to have a bicornuate uterus, with the fetus confined to one cornu. The baby was delivered prematurely at 29 weeks of gestation due to the mother progressing into preterm labor. The newborn, a female, had a birth weight of 1.3 kg, cried after stimulation, and was admitted to the neonatal intensive care unit (NICU) due to respiratory distress, prematurity, and very low birth weight (VLBW).

A distinctive finding in the baby was fixed hyperextension of the knees with flexion at the hips, which was suspected to be a severe compression deformity caused by intrauterine space restriction. The baby was started on treatment for prematurity, respiratory distress, and VLBW. An orthopedic consultation was sought, and after clinical examination and radiological investigations, a diagnosis of congenital dislocation of the knee was confirmed.

The baby was initiated on traction of both lower limbs and was planned for a Pavlik harness once stabilized, as early treatment is crucial to prevent further contracture formation and worsening deformity.

Congenital dislocation of the knee (CDK) is a rare condition that requires prompt diagnosis and treatment to ensure proper limb function and prevent long-term complications [3]. The condition is often associated with intrauterine mechanical factors, as seen in this case, where the presence of a bicornuate uterus likely led to space constraints, resulting in the fixed hyperextension of the knees [2]. Limited intrauterine space has been recognized as a potential risk factor for CDK, as it restricts normal fetal movements and joint development [4].

Prematurity and very low birth weight (VLBW) may further contribute to musculoskeletal abnormalities, as these infants often have reduced muscle tone and underdeveloped connective tissues, making them more susceptible to joint deformities [5]. In this case, the combination of prematurity, intrauterine constraint, and mechanical forces likely played a role in the development of CDK [2].

Early management is critical in CDK, as delaying treatment can lead to secondary contractures and long-term gait abnormalities [6]. Conservative approaches such as serial casting, stretching exercises, and splinting are effective in mild to moderate cases, while severe cases may require surgical intervention [7]. In this case, the use of traction followed by a Pavlik harness was planned, which is a well-established method for gradually correcting the dislocation and improving joint alignment [8].

A multidisciplinary approach involving neonatologists, orthopedic specialists, and physiotherapists is essential for optimal outcomes in CDK cases [9]. Continuous monitoring and early physiotherapy interventions help in preventing residual deformities and improving joint mobility [10]. Given the association between CDK and other musculoskeletal anomalies, thorough clinical and radiological evaluations should be conducted to rule out concurrent conditions such as developmental dysplasia of the hip (DDH) or clubfoot

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