Abdullrab AlmarwanyaCongenital hyperextension of the knee: Classified as congenital hyperextension, subluxation, or dislocation of the knee based on physical examination and radiographic asse. The degree of passive flexion of the knee also helps determine prognosis and treatment. Grade 1 (congenital hyperextension of the knee) the knee flex and reduce with gentle stretching of the quadriceps, . Grade 2 ( congenital subluxation of the knee) the knee will not flex beyond neutral. Grade 3 ( true irreducible congenital dislocation of the knee (CDK) knee flexion is not possible . Planning : A true lateral radiograph of the knee may help to differentiate between the three. Assess for concomitant lower extremity deformities,hyperlaxity syndromes ,neuromuscular dislocations such as arthrogryposis or myelomeningocele . Treatment should begin as soon as possible with gentle manipulation of the tibia into a flexed position with longitudinal traction to the tibia and pressure in an AP direction to bring it around the femoral condyles maintaine new position in a cast or splint.Once 30 degrees or more of flexion is obtained, the knee will usually further flex to 90 degrees with one or two more manipulations. Once 90 degrees of flexion is obtained, a removable splint can be used for a few months to maintain correction. Recurrence is unusual. Surgical treatment for knees that do not respond to serial manipulations may be done as early as 6 month to 1 year of age.