Genu recurvatum is a deformity in the knee joint. It can have significant consequences for mobility.
What is genu recurvatum?
Genu is the Latin name for the knee, and recurvatum means bent back or backward. Accordingly, the term genu recurvatum is used to describe a deformity in the knee joint that is characterized by hyperextension. It is particularly visible during walking, when the affected leg is loaded in the stance leg phase. Normally, true extension in the knee joint is not possible in most adults. They barely reach the zero position. In the case of genu recurvatum, hyperextensions of ten to fifteen degrees Celsius or more are achieved. Extension in the knee joint is physiologically limited by connective tissue structures. The collateral ligaments and the posterior cruciate ligament contribute in part. However, it is primarily the joint capsule, which is reinforced in the posterior region, that stops further movement. During simultaneous flexion at the hip joint, the posterior thigh muscles prevent the joint from reaching the zero position when their stretching capacity is reduced. Muscular control in stance and walking is provided by the joint stabilizing muscles. In addition to the knee flexors, this is primarily the quadriceps femoris muscle (four-headed thigh muscle). All muscles work together synergistically in this function.
Causes
A genu recurvatum can have several causes, but all ultimately result in connective tissue becoming overstretched and losing its limiting function. Mild hyperextension can result from a genetically predisposed weakness of connective tissue. It is kept in check in that case because the controlling muscular system is functioning. High-grade hypermobility in the knee results from incomplete or complete paralysis of the muscles that provide stability to the knee, especially the quadriceps femoris muscle. The stance and the weight-bearing phases during walking can no longer be maintained muscularly, or only partially. The joint is therefore brought into the hyperextended position because the bones and connective tissue structures provide it with support there. Flaccid paralysis of the leg muscles can occur as a result of a spinal cord injury with a paraplegic problem or in the context of poliomyelitis. These conditions usually involve more than just the knee muscles. Isolated paralysis of the quadriceps femoris muscle can be caused by injuries in the pelvic region, surgical errors or herniated discs at the level of segments L2 – L4. A tibial plateau fracture healed in malposition may also result in genu recurvatum.
Symptoms, complaints, and signs
The first sign that indicates a genu recurvatum is the visual impression, especially when looking at the unclothed legs while standing or walking. If the deformity is unilateral, this feature is even more noticeable because the gait pattern becomes asymmetrical. Pain can occur where tissue is overloaded by pressure or traction. This initially affects the overstretched structures in the region of the popliteal fossa. The dorsal capsular shell and soft tissues in this area are put under tremendous tensile stress with each step and while standing and react very painfully. Over time, a habituation effect occurs that shifts the pain intensity into a tolerable range. In the case of genu recurvatum, the two joint partners of the knee joint have to withstand more pressure than normal. This is because the two bones are in an awkward position relative to each other, where the pressure is distributed over a small area. When the articular cartilage no longer provides enough protection, this leads to pain at the bone.
Diagnosis and progression
Diagnosis of genu recurvatum is primarily based on clinical examination. Inspection while standing and walking, joint measurements, and tests of joint stability usually already give the physician enough clues to make a diagnosis. Radiographs may be used as a diagnostic tool if bone involvement is suspected. A genu recurvatum develops gradually because the limiting connective tissue yields only slowly. The degree of expression depends on the causative factors, especially on whether stabilizing muscles are still functioning or not. As a result of the malposition, arthrosis may develop in the knee joint (gonarthrosis).
Complications
Genu recurvatum causes severe limitations in the patient’s movement. In this case, the disease can also be detected relatively quickly and easily visually, so that treatment can begin at an early stage. Similarly, the patient can no longer move symmetrically and may be dependent on a walking aid to cope with everyday life. In addition to the limitations, severe pain also occurs, which can take the form of pressure pain or pain at rest. The affected person is no longer able to put weight on his legs and joints in the usual way, which also greatly reduces the quality of life. As the disease progresses, pain in the bones also occurs. Treatment of genu recurvatum can only be performed if there is no paralysis. If the patient is paralyzed, treatment is not possible. In this case, it is symptomatic and aimed at reducing the movement restrictions and pain. In most cases, there are no further complications. However, not all restrictions can be treated easily either. It is not uncommon for psychological discomfort and depression to occur due to the limitations in movement.
When should you see a doctor?
If there is a visual change in the knee joint, a doctor should be consulted. If a shape of the knee is shown when walking or standing, which is strongly modified in relation to the fellow, a visit to the doctor should take place. If there is pain or impairment in locomotion, it is advisable to see a doctor. If the pain spreads or increases in intensity, a medical evaluation is necessary. Consultation with a medical professional is necessary before taking any pain medication to avoid complications or further impairment. If the knee joint can be unusually overstretched, it is recommended to have the overstretching examined by a physician. If emotional or psychological problems occur as a result of the visual changes, a physician should be consulted. If there are undesirable changes in the personality, abnormalities in behavior or an inner restlessness, a doctor should be consulted. If there is a reduction in well-being, a feeling of illness or withdrawal behavior, the affected person needs help and support. If there are skin changes, redness or swelling, this is considered unusual. A visit to the doctor is necessary to find out the causes of the abnormalities. If the usual performance level drops and sports activities can no longer be performed, a visit to the doctor is recommended.
Treatment and therapy
Conservative treatment of genu recurvatum consists of a combination of different measures. These include physiotherapeutic measures, a supply of assistive devices, and symptomatic administration of medications. Physiotherapy works out with the patients specific strengthening possibilities, for the activation of the knee flexors, so that they can better control the knee’s punching through. On the other hand, special attention is given to training the quadriceps to regain better stability control. Methods from electrostimulation can also be used for support. All these measures presuppose that there is still some function of the muscles. If there is complete paralysis, the application is not effective. Certain aids can be used to limit the hyperextensibility of the knee in order to spare the overstretched structures. Splints or orthoses are suitable for this purpose. To maintain the ability to walk, the prescription of walking aids can be an effective means. Depending on the severity of the loss of function, crutches, walking sticks or rollators may be used, and in extreme cases, a walker. In the case of severe changes, surgical therapy consists of correcting the axial malposition by means of an osteotomy. This operation is very complex and stressful and is only performed if there is a prospect of functional improvement or if the level of suffering is too great.
Outlook and prognosis
The prognosis of genu recurvatum is unfavorable for patients who already have the stage of paralysis. In this case, adequate mobility of the knee joint cannot be established. The movement restrictions remain despite all efforts.With an early diagnosis and a quick start of treatment, an improvement of the symptoms can be achieved with various therapeutic as well as medical options. The prognosis for these patients is significantly more optimistic. Mobility is trained in exercise units specially adapted to the patient’s needs. This supports the muscular system as well as the ability to walk. The aim is to achieve an improved functional ability and thus to promote the quality of life of the affected person. However, complete freedom from symptoms is not always achieved. Rather, long-term treatment takes place so that optimal support can be provided in coping with the disease. Patients who require surgical intervention often face major challenges. Surgery is usually considered a last resort and is only used when all other therapies have been exhausted. Deformities are corrected in patients. The procedure is very complex and involves a great deal of effort. If the procedure proceeds without complications, an overall improvement in symptoms can be observed. However, the healing process is lengthy.
Prevention
Active prevention to prevent the development or worsening of genu recurvatum is only possible if muscle function is at least partially preserved. Especially for people with connective tissue weakness, regular training of the muscles involved is a promising way to achieve long-term improvement in joint position. However, it is important that the strengthening is accompanied by training in body awareness. Only this will ensure that the muscles that can prevent genu recurvatum are actually trained in this function.
Aftercare
In most cases, no special aftercare is possible or necessary for genu recurvatum. The affected person is primarily dependent on direct treatment of this deformity. Self-healing cannot occur in this case, so medical treatment is always necessary. Although the life expectancy of the affected person is not reduced by genu recurvatum, the mobility of the patient can suffer greatly as a result of this disease. In most cases, the disease is treated by physiotherapy measures and by taking various medications. Some of the exercises from this therapy can also be performed in the patient’s own home, which may speed up the healing process. When taking medications, care must be taken to ensure that they are taken correctly, and interactions must also be considered. In many cases, patients with genu recurvatum are dependent on the support of their own family and friends to make everyday life easier. In this case, especially very loving and intensive care of the affected person has a positive effect on the further course of the disease. The use of walking aids can also be supportive.
What you can do yourself
For patients, genu recurvatum is accompanied by considerable restrictions on their usual mobility and, apart from the physical suffering, also represents an enormous psychological challenge. Despite the shame of the usually visible disease, it is important that those affected do not withdraw and continue to maintain social contacts. In this way, it is possible to prevent depression and other psychological sequelae caused by the genu recurvatum. It is also possible to make contact with other sufferers, for example in the form of self-help groups, in order to deal with the burden together and thus forfeit less quality of life. For dealing with pain, each patient finds at best individual ways to provide relief from the unpleasant sensations in the affected areas. Possible options include pain-relieving ointments and baths. In general, it is important that patients also perform the exercises rehearsed with the physiotherapist at home. Regular exercise strengthens the muscles and tendons, so that pain sometimes decreases and the quality of life improves. In certain cases, walking aids are necessary to move safely despite genu recurvatum. At home, crutches or rollators also support mobility and the performance of various household tasks, making everyday life easier.
