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Dean RS, Graden NR, Kahat DH, et al. Treatment for Symptomatic Genu Recurvatum: A Systematic Review. Orthop J Sports Med. 2020;8(8):2325967120944113doi: 10.1177/2325967120944113.
Dean, R. S., Graden, N. R., Kahat, D. H., DePhillipo, N. N., & LaPrade, R. F. (2020). Treatment for Symptomatic Genu Recurvatum: A Systematic Review. Orthopaedic journal of sports medicine, 8(8), 2325967120944113. https://doi.org/10.1177/2325967120944113
Dean, Robert S, et al. "Treatment for Symptomatic Genu Recurvatum: A Systematic Review." Orthopaedic journal of sports medicine vol. 8,8 (2020): 2325967120944113. doi: https://doi.org/10.1177/2325967120944113
Dean RS, Graden NR, Kahat DH, DePhillipo NN, LaPrade RF. Treatment for Symptomatic Genu Recurvatum: A Systematic Review. Orthop J Sports Med. 2020 Aug 12;8(8):2325967120944113. doi: 10.1177/2325967120944113. eCollection 2020 Aug. PMID: 32851107; PMCID: PMC7425269.
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Orthop J Sports Med. 2020 Aug 12;8(8):2325967120944113. doi: 10.1177/2325967120944113. eCollection 2020 Aug.

Treatment for Symptomatic Genu Recurvatum: A Systematic Review.

Orthopaedic journal of sports medicine

Robert S Dean, Nathan R Graden, David H Kahat, Nicholas N DePhillipo, Robert F LaPrade

Affiliations

  1. Twin Cities Orthopedics, Edina, Minnesota, USA.
  2. University of Minnesota Medical School, Minneapolis, Minnesota, USA.
  3. Oslo Sports Trauma Research Center, Oslo, Norway.

PMID: 32851107 PMCID: PMC7425269 DOI: 10.1177/2325967120944113

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.

© The Author(s) 2020.

Keywords: complex knee; genu recurvatum; heel height; proximal tibial osteotomy; tibial slope

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: R.F.L. has received grant support from Arthrex, Linvatec, Ossur, and Smith & Nephew; educatio

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