Proximal Tibial Recurvatum-Valgus: Analysis and Treatment

J Am Acad Orthop Surg. 2023 Dec 8. doi: 10.5435/JAAOS-D-23-00642. Online ahead of print.ABSTRACTGenu recurvatum-valgus arises from the proximal tibia and poses challenges in its treatment. The etiology of the combined deformities can include physeal trauma (often unrecognized), iatrogenic injury, infection, tumor, Osgood-Schlatter syndrome, skeletal dysplasia, and ligamentous laxity. Both osseous and ligamentous contributions must be recognized for successful treatment. A graphical planning method identifies the true (oblique) plane of deformity. Surgical treatment options include epiphysiodesis to prevent progressive deformity, guided growth, opening-wedge proximal tibial osteotomy, and gradual correction with concomitant limb lengthening using external fixation or motorized internal lengthening. Opening-wedge proximal tibial osteotomy conducted along the true deformity plane is a reliable surgical method for lesser-magnitude deformities. Gradual correction using circular external fixation is considered when the magnitude of correction is greater than 25ยบ or when limb shortening and/or multiplanar deformity is present. After successful surgical management, patients can expect to achieve correction of knee hyperextension, posterior tibial slope, and mechanical axis. Restoration of these parameters re-establishes physiologic loading of the knee. This review illustrates the clinical and radiographic assessment of the deformity, relevant anatomy, and five surgical techniques fo...
Source: The Journal of the American Academy of Orthopaedic Surgeons - Category: Orthopaedics Authors: Source Type: research