Treatment should be started as soon as possible.
Consists of gentle manipulation and serial casting aiming to achieve at least 90 degrees of flexion. Removable splints can be used to maintain the position obtained. Conservative treatment is often successful in idiopathic CDK but results are less predictable in syndromic CKD. 1-4
Operative treatment is indicated if manipulations and serial casting fail. This can be done between 6 months to 1 year of age.
Classically, surgical treatment for CDK was a distal V-Y Quadricepsplasty (Thompson’s procedure) 5 usually complicated by a severe extension lag.
Proximal sequential quadricepsplasty in association with release of the intra-articular adhesions and mobilization of the suprapatellar pouch (Judet’s technique) 6 showed better clinical results and became more popular.
In recent years, femoral shortening osteotomy has been done to minimize the extensive quadriceps release, while anterior cruciate ligament (ACL) reconstruction has been associated to address the coexistent ligaments deficiency. 7,8