Treatment for Symptomatic Genu Recurvatum: A Systematic Review

Abstract

Background: Symptomatic genu recurvatum is a challenging condition to treat. Both osseous and soft tissue treatment options have been reported to address symptomatic genu recurvatum. Purpose/Hypothesis: The purpose of this article was to review the current literature on surgical treatment options for symptomatic genu recurvatum and to describe the associated clinical outcomes. We hypothesized that anterior opening-wedge proximal tibial osteotomy (PTO) would be the most common surgical technique described in the literature and that this intervention would allow for successful long-term management of symptomatic genu recurvatum. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with the inclusion criterion of surgical treatment options for symptomatic genu recurvatum. Recurvatum secondary to polio, cerebrovascular accident, or cerebral palsy was excluded from this review. Results: A total of 311 studies were identified, of which 6 studies with a total of 80 patients met the inclusion criteria. Causes of genu recurvatum included physeal arrest; soft tissue laxity; and complications related to fractures, such as prolonged immobilization and malalignment. Mean follow-up times ranged from 1 to 14.5 years postoperatively. There were 5 studies that described anterior opening-wedge PTO, 2 of which used the Ilizarov distraction technique. All 3 studies that used PTO without the Ilizarov technique reported correction of recurvatum and increased posterior tibial slope; 2 of these studies also included subjective outcomes scores, reporting good or excellent outcomes in 70% (21/30) of patients. Of the studies that used the Ilizarov technique, both reported correction of recurvatum and increased posterior slope from preoperative to postoperative assessments. Both of these studies reported good or excellent subjective outcomes postoperatively in 89.5% (17/19) of patients. Additionally, 1 study successfully corrected recurvatum by performing a retensioning of the posterior capsule to address knee hyperextension, although follow-up was limited to 1 year postoperatively. Conclusion: Anterior opening-wedge PTO, with or without postoperative external fixation with progressive distraction, was found to be a reliable surgical treatment for symptomatic genu recurvatum. After surgical management with PTO, patients can expect to achieve correction of knee hyperextension, restoration of a more posterior tibial slope, and increased subjective outcome scores.

Genu Recurvatum After Prolonged Bracing for Drop-Foot in a Patient With History of Guillain-Barre Syndrome

“…On the other hand, prolonged immobilization of the lower limb in patients with open growth plates has been accused for early arrest of the proximal tibial growth plate of the tibia [3]. Other authors support, that partial growth arrest of the proximal tibial metaphysis may result from direct pressure on the proximal tibia either from a long-limb cast or from a patellar tendon bearing brace [1,[6][7][8][9][18][19][20].…”

“…Various factors may lead to GR [1]. Direct trauma with or without fracture of the proximal tibia, surgical intervention on the proximal tibia, prolonged skeletal tibial traction, osteomyelitis, irradiation, Osgood-Schlatter disease, prolonged immobilization, direct plaster cast or brace pressure on the proximal tibial physis, ligamentous laxity, posterolateral corner insufficiency, gastrocnemius weakness, tumors, cerebrovascular accident and poliomyelitis correlate with the deformity [1][2][3][4][5][6]. Congenital, hereditary and idiopathic cases have also been reported [1,[7][8][9].…”

“…The affected lower limb presents a hyperextended knee and is shorter than the contralateral. As a result, the posture and the gait of the individual is greatly affected and disabled [ 1 , 2 ].…”

“…It has been reported, that knee hyperextension is an independent predictor of knee stability and function and predisposes to ACL graft impingement and failure of ACL reconstruction [ 10 ]. Whatever the cause, GR may lead to symptoms, such as pain or instability of the affected knee, patellofemoral disorders, leg length discrepancy and gait disturbance [ 1 , 7 ].…”

“…Dejour supports, that a pathologic GR is always acquired and unilateral [ 7 ]. It has been suggested, that a symptomatic GR greater than 5⁰ should be evaluated and treated [ 1 , 5 ]. However, a recurvatum greater than 15⁰ should always be considered as pathologic and should be treated to restore normal mechanical conditions of the knee and to improve the quality of life of the patient [ 2 , 12 ].…”