Die kongenitale Kniegelenkdislokation : neue Erkenntnisse in Ätiologie, Pathogenese, Diagnose und Therapie der verschiedenen Grade der Kniegelenkdislokation

The goal of this paper is to assess and extend the current knowledge and understanding of aetiology, pathogenesis and treatment of congenital dislocation of the knee. This thesis contains an overview of the literature, in which the literature of the past 116 years is presented and analysed critically. Special emphasis is made on the treatment aspect with regard to the fact that a new treatment of congenital dislocation of the knee is presented and compared to current treatments by taking into account implementation, flexibility and results. Within the framework of this thesis, the data of seven patients suffering from a congenital dislocation of the knee was analysed. In addition to this, the treatment and therapy results are compared with the data of a patient who received treatment for the most important differential diagnosis, the genu recurvatum congenitum. In the course of this thesis, it will be determined that different nomenclatures, translations and definitions of congenital dislocation of the knee lead to a lack of clarity in the treatment and prognosis of the disease. A uniform nomenclature is therefore devised. This nomenclature is consistent with the applied classification according to Niethard et al. (2005), which was employed in this thesis due to its relative clarity in terms of different levels of development and different dynamics in comparison with other models. This thesis, however, was also unable to determine unambiguous aetiological similarities due to the heterogeneity of the associated findings and concomitant diseases. Four of the seven patients in the patient population received conservative treatment only, and three were treated surgically with a Fixateur externe. The patients who only received conservative treatment were partly unavailable for follow-up examinations; their final diagnoses in their files, however, revealed an average flexion of 90°. In case of patients with syndrome diseases, the treatment results in our patient population demonstrate a clear improvement in the ability to flex the knee. The patients often suffer from re-luxations of the knee and some of them are still receiving treatment. Due to significant differences between the therapeutic methods in the literature, a treatment algorithm for congenital dislocation of the knee was also developed. In accordance with the opinions of many authors, a conservative treatment of the knee is attempted initially and surgical treatment is performed only after its failure. The application of a Fixateur externe according to Ilizarov, which constitutes a significant extension of the range of surgical treatments, is also presented in detail in this thesis and in comparison with the possibilities of tendon lengthening. This thesis was able to determine that this procedure allows for a considerably greater degree of flexibility during treatment, since it can be used for recurrent as well as dorsal dislocations and can even be computer-controlled via the TSF Hexapod System