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Genu recurvatum is hyperextension of the knee to more than 5 degrees and can result from misalignment of the ankle joint, knee injuries, or postural habits. It can cause stress in the ACL and lead to permanent damage. Treatment includes physical therapy, orthotics, knee braces, and surgery.
Genu recurvatum, or “posterior knee,” is hyperextension of the knee to more than 5 degrees. The three types of genu recurvatum are external rotational deformity (ERD) recurvatum, internal rotational deformity (IRD) recurvatum, and nonrotary deformity (NRD) recurvatum. Knee hyperextension is sometimes the result of a misalignment of the ankle joint; it can also result from knee injuries, excessive laxity in the knee joint, or postural habits. Knee hyperextension can cause stress in the anterior cruciate ligament (ACL) and posterior structures of the knee and lead to permanent damage to the joint. Physical therapists often tap or brace the knee in patients who have knee recurvation, and therapists provide proprioceptive training, correction of muscle imbalance, and gait training.
Genu recurvatum occurs more often in females than in males. Abnormal position of the foot and ankle during walking or injuries involving hyperextension of the knee can cause genu recurvatum. Symptoms include pain in the medial tibiofemoral joint, which is the inside of the leg at the knee, or in the posterolateral ligament structures at the outside back of the knee. Untreated genu recurvatum leads to increased tissue damage and can cause permanent deformity, so prompt diagnosis and treatment is important.
External rotation recurvatum deformity occurs when the foot remains in the equinovarial position during walking, with the heel lifted and the toes pointed inward, which causes hyperextension of the knee. ERD is usually seen in stroke patients whose foot movements become abnormal due to an abnormal pattern of muscle tone. Internal rotational recurvatum deformity begins with an abnormal gait in which the ball of the foot is rotated outward, which causes the person to compensate by overextending the knee, leading to a recurvatum deformity. In the case of nonrotary recurvatum deformity, the foot and ankle are positioned normally and the knee is the primary abnormality. An injury that forces the knee into hyperextension is usually the cause of NRD.
All three types of genu recurvatum place great strain on the knee and cause increased joint deformity if not corrected. Untreated ERD leads to increased soft tissue damage, as well as permanent knee and knee valgus deformities. IRD produces a less severe recurvatum deformity, along with genu varum, or “bow legs.” NRD causes increased stress to the posterior soft tissue structures of the knee, which leads to increased recurvatum deformity.
Doctors use X-rays or magnetic resonance imaging (MRI) along with gait analysis to diagnose and classify genu recurvatum. Patients suffering from ERD or IRD usually require orthotics to correct the positioning of the ankle. Physical therapists might tape the knee for support in mild cases. Patients who have more severe recurvatum may require knee braces.
Gait training, balance exercises, and proprioceptive exercises can help improve mild to moderate recurvate, as can exercises to strengthen the quadriceps and gastrocnemius muscles. Treatment depends on the type and severity of the recurvatum. Some cases require surgery to repair damage to the knee.
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