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Between 1985 and 1995, we treated seven cases of CDK in five patients (four girls, one boy) with serial splinting. Two patients had bilateral dislocation of the knees, two had unilateral subluxation of the knees, and one patient with unilateral knee dislocation also had congenital dislocation of the ipsilateral hip. There were no other associated congenital anomalies. Three of the children had normal cephalic deliveries at full term. One child who had bilateral CDK was born in breech position, and the other was delivered by caesarean section at 31 weeks. At birth, hyperextension of the knees ranged from 25 to 90 ° and flexion from 0 to 30 °. All these children were treated with serial posterior splints in varying degrees of flexion for between 2 and 5 months. The follow-up period ranged from 9 months to 4 years.
Of the six cases treated by Haga et al. (1), they found at final follow-up that four had persistent hyperextension of 10-20°. We found that our results at final follow-up were better. Four of our cases had no hyperextension and full flexion, and one child had hyperextension of 5 ° but did not complain of disability. The last child born in 1995 with bilateral CDK had 25 ° of hyperextension and 130 ° of flexion at 9 months' follow-up and is still receiving physiotherapy.
All our patients were splinted immediately after the diagnosis was made. We did not wait to see whether the knees would spontaneously reduce. Retrospectively, some of our cases may have spontaneously reduced without the use of splints. We agree with Haga et al. (1) that a period of observation in CDK in cases not associated with clubfoot, arthrogryposis multiplex congenita, and Larsen's syndrome may allow spontaneous reduction. Otherwise, good results can be achieved with the use of serial splints, as shown by our series.
