Knee Recurvatum in Children With Spastic Diplegic Cerebral Palsy

Bauer, Jeremy; Patrick, K.; Feng, Jing; Pierce, Rosemary; Aiona, Michael D.

doi:10.1097/bpo.0000000000000985

Cited by 14 publications

(14 citation statements)

References 12 publications

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“…The results showed that knee hyperextension was reduced in the early recurvatum group but not in the late recurvatum group after calf lengthening, which indicates early knee recurvatum is associated with calf contractures and late knee recurvatum is not associated with calf contractures and is possibly more associated with a late spastic response. Bauer et al 10 previously found that children who had knee hyperextension in early stance were more likely to have a contracture of the gastroc-soleus compared with children who had hyperextension in late stance. Therefore the majority of children with late knee recurvatum did not have calf contractures.…”

Section: Discussionmentioning

confidence: 99%

“… 3 - 7 However, there is a subset of children that walk with knee recurvatum 8 , 9 with less known about the natural history and treatment of this pattern. Bauer et al 10 examined a cohort of children that had passive knee hyperextension on clinical exam and determined that the presence of contracture or spasticity of the gastroc-soleus complex and the consequent plantar-flexion knee extension couple led to knee hyperextension in stance phase. Bauer et al 10 also found that children who had knee hyperextension in early stance were more likely to have a contracture of the gastroc-soleus than children who had hyperextension in late stance.…”

Section: Introductionmentioning

confidence: 99%

“…Bauer et al 10 examined a cohort of children that had passive knee hyperextension on clinical exam and determined that the presence of contracture or spasticity of the gastroc-soleus complex and the consequent plantar-flexion knee extension couple led to knee hyperextension in stance phase. Bauer et al 10 also found that children who had knee hyperextension in early stance were more likely to have a contracture of the gastroc-soleus than children who had hyperextension in late stance. Given the difficulty in treatment of the knee hyperextension, we aimed to examine the results of surgical intervention in a similar group of patients who have dynamic knee recurvatum and who underwent calf lengthening surgery.…”

Section: Introductionmentioning

confidence: 99%

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Calf lengthening may improve knee recurvatum in specific children with spastic diplegic cerebral palsy

Bauer

Patrick

Feng

et al. 2020

Journal of Children's Orthopaedics

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Purpose Knee hyperextension in stance is a difficult condition to treat in children with spastic diplegic cerebral palsy (CP). In children with passive knee hyperextension, the presence of contracture or spasticity of the calf leads to knee hyperextension in stance phase. We hypothesize surgical treatment of the contracture of the calf will lead to less knee hyperextension. Methods We performed a retrospective review of children who were evaluated in our movement laboratory over 23 years with a diagnosis of CP Gross Motor Function Classification System I, II or III. We selected children who had passive knee hyperextension on exam and who underwent calf lengthening surgery. Children were divided into two groups: early recurvatum (ER) (n = 20) and late recurvatum (LR) (n = 14). Results There was no difference in the preoperative passive knee extension among the groups or the surgeries performed. For children who had passive knee hyperextension, calf lengthening improved static dorsiflexion with knee flexion on clinical exam by 9.3° in the ER group, 9.6° in the LR group as well as dorsiflexion with knee extension on clinical exam by 9.5° in the ER group and 6.4° in the LR group. The kinematic data showed that the ER group improved their knee hyperextension by 11° (p < 0.001), whereas the LR group did not significantly change their stance phase knee position. Conclusion Children with passive knee hyperextension who have a calf contracture and walk in knee hyperextension in the first half of stance phase may improve after calf lengthening. Level of Evidence: III

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Calf lengthening may improve knee recurvatum in specific children with spastic diplegic cerebral palsy

Bauer

Patrick

Feng

et al. 2020

Journal of Children's Orthopaedics

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“…Recurvatum is an unusual deformity of the knee in children and amongst its causes are conditions such as arthrogryposis (4) , cerebral palsy (5)(6)(7) , poliomyelitis, sequelae of the tibial tuberosity fracture (8,9) , and some syndromes with generalized joint hypermobility (1,10) . When there is a structured equinus deformity of the ankle and foot, the knee with joint hypermo-bility can deform into recurvatum due to the vector resulting from the relative posteriorization of the proximal tibia and anteriorization of the load axis to the knee.…”

Section: Introductionmentioning

confidence: 99%

Posterior femoral hemiepiphysiodesis for genu recurvatum with equinus foot deformity: a novel surgical proposal

2022

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Genu recurvatum is characterized as an hyperextension deformity of the knee in the sagittal plane and can be associated to structured equinus deformity of the ankle and foot. Amongst its causes are conditions like arthrogryposis, cerebral palsy, tibial tuberosity arrest, poliomyelitis and syndromes with generalized ligamentous hyperlaxity. The treatment of this condition can be challenging, specially when associated with equinus of the foot and, to date, aggressive methods such as femur or tibia osteotomies are the most used for its correction. We describe here a safe and minimally invasive technique with posterior hemiepiphysiodesis of the distal femur performed with transphyseal screws for correction of the genu recurvatum with apex on the distal femur associated with rigid equinus of the foot due to tarsal coalition. This technique has great potential for correcting the recurvate knee in the immature skeleton and can be an excellent alternative to the more aggressive methods currently used for the treatment of this deformity. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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“…Both congenital and acquired etiologies can give rise to genu recurvatum, with variable clinical presentation. [1][2][3][4][5][6] Nonoperative management may be appropriate for select patients, but a greater magnitude of anterior tibial slope is often effectively treated with anterior opening wedge high tibial osteotomy (OW-HTO), with or without external fixation 7 . Occasionally, genu recurvatum coincides with coronal malalignment (e.g., genu valgum), which may complicate surgical planning.…”

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confidence: 99%

Single-Stage Correction of Genu Valgum Recurvatum by Distal Femoral and High Tibial Opening Wedge Osteotomies

Setliff

Engler

Zsidai

et al. 2023

JBJS Case Connector

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Case: A 32-year-old woman with genu valgum recurvatum presented to clinic complaining of long-standing anterior knee pain. Radiographs demonstrated a 13°anterior tibial slope and 15°valgus malalignment. She underwent a single-stage 2-level osteotomy at the distal femur and proximal tibia to simultaneously correct genu valgum and recurvatum. This procedure achieved precise correction in both planes. At 1 year, the patient was pain-free and ambulated without restriction. Conclusion:This procedure should be considered among the available surgical options when treating genu valgum recurvatum because it produced excellent results for the studied patient. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C130).

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Knee Recurvatum in Children With Spastic Diplegic Cerebral Palsy

Abstract: Level III-case-control study.

Cited by 14 publications

References 12 publications

Calf lengthening may improve knee recurvatum in specific children with spastic diplegic cerebral palsy

Calf lengthening may improve knee recurvatum in specific children with spastic diplegic cerebral palsy

Posterior femoral hemiepiphysiodesis for genu recurvatum with equinus foot deformity: a novel surgical proposal

Single-Stage Correction of Genu Valgum Recurvatum by Distal Femoral and High Tibial Opening Wedge Osteotomies

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