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Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Variations in the anatomical angle lead to genu valgum (<165°) or genu varum (>180°). The valgus or varus attitude at the knee is best observed in the standing position. In the sagittal plane, there may be hyperextension at the knee resulting in genu recurvatum, which may be physiological in hyper lax children or pathological as seen in children with congenital knee dislocation (Figure 10.2a).
Answers
Published in Thomas Hester, Iain MacGarrow, Surgical SBAs for Finals with Explanatory Answers, 2018
In an acute flare-up of rheumatoid arthritis, there is often an effusion present and thickened synovium. The joint is usually tender. Genu recurvatum is often associated with connective tissue disorders, e.g. Ehlers-Danlos syndrome, which is seen as hyperextension of the knee upon standing.
Ultrasonography findings and physical examination outcomes in dancers with and without patellofemoral pain
Published in The Physician and Sportsmedicine, 2018
Itzhak Siev-Ner, Myriam D Stern, Shay Tenenbaum, Alexander Blankstein, Aviva Zeev, Nili Steinberg
A high prevalence (38.6%) of knee genu recurvatum was found in this cohort, with significant association between genu recurvatum and PFP. Previously, the authors have hypothesized that dancers have knee injuries and pain due to extreme ligamentous laxity, leading to excessive stress on the knee joint [15]. Genu recurvatum is an esthetic feature of classical ballet that may be associated with strain and pain to the knees [36]. Complex dance techniques, such as plié and grand plié, involve deep flexion of the legs at the knee and hip. The required degree of knee flexion increases the patellofemoral joint reaction force [37], and repetitive movements in these position may contribute to extensor mechanism overuse injuries such as PFP in hyperextended knees [37]. Furthermore, when dancers perform stressful dance movements such as plié and relevé, the quadriceps femoris should elevate the patella in a vertical direction along the trochlear groove [38]. Yet, when the knee is hypermobile, muscle activation of the rectus femoris is less effective, increasing the force of contact between the patella and the femur and resulting in a gradual grinding of the cartilage of the patella and femur [7,39]. Dancers with genu recurvatum might experience decreased strength of the quadriceps femoris muscle, leading to increased load on their knees, predisposing to knee injuries [40]. Yet, few other reports found a lack of relation between hyperextension of the knee and PFP [7,24].
Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report
Published in Physiotherapy Theory and Practice, 2019
William R. VanWye, Harvey W. Wallmann, Elizabeth S. Norris, Karen E. Furgal
The patient presented with left ankle plantarflexor weakness. Ankle plantarflexion weakness may result in diminished eccentric control of forward momentum in the mid and terminal stance phases (Perry and Burnfield, 2010). During the gait cycle, limb stability in early mid-stance is largely due to the influence of the gastrocnemius and soleus muscles (Perry and Burnfield, 2010). This may explain the observation of left genu recurvatum in stance during gait analysis. Genu recurvatum can cause compressive forces at the knee, thereby possibly contributing to the patient’s anterior pain (Loudon, Goist, and Loudon, 1998). Also, gait analysis revealed increased left subtalar joint pronation (i.e. rearfoot eversion) in left stance when compared to the right. Although anterior knee pain has been linked to excessive subtalar joint pronation (Levinger and Gilleard, 2004; Rodrigues et al, 2015), a 2017 international consensus statement concluded that dynamic foot function is not consistently associated with anterior knee pain (Powers, Witvrouw, Davis, and Crossley, 2017). However, excessive foot pronation during weight bearing tasks may contribute to anterior knee pain if corresponding internal rotation of the tibia and the femur occur creating a dynamic valgus movement pattern at the knee (Petersen, Rembitzki, and Liebau, 2017). Interestingly, in addition to left ankle plantarflexor weakness, the patient also exhibited left gluteal maximus and medius weakness. Gluteal weakness could have potentially resulted in increased femoral internal rotation during left LE weight bearing. Considering these factors, it appeared plausible that the patient’s plantarflexor and gluteal muscular weakness may have been responsible for causing a dynamic valgus movement pattern, resulting in anterior knee pain.
Complications after tibial tubercle traction and femoral neck fractures in children: a case report
Published in Postgraduate Medicine, 2021
Fuyuan Deng, Zhong Li, Juncai Liu
There are many surgical treatments for genu recurvatum and different surgical techniques that can effectively correct this problem. At present, there is still controversy over the optimal surgical methods. Therefore, patients’ condition should be comprehensively evaluated and appropriate treatment methods should be selected for effective treatment. The wedge correction of the distal tibia can effectively correct the deformity. But the fibula osteotomy must be performed and delayed fracture healing or even nonunion may occur. Bone grafting can effectively improve the healing ability of the osteotomy area. The proximal tibial tuberosity is incised and the wedge-shaped osteotomy is close to the center of the deformity. The correction angle is adjustable. It is located at the metaphysis and heals well, but it may still lead to patella Baja and some patients still need tibial tuberosity displacement [18]. The fracture healing is faster, while the closed osteotomy is complicated and difficult to operate. Kim TW [19] proposed a new technique in 2017 that does not require fibular osteotomy. It can improve the accuracy of deformity correction, without complications such as low patella and insufficient correction. On the contrary, due to the small number of cases, further researches are still needed. Boonrod [20] put forward a new operation that involves osteotomy at the distal tibial tuberosity, in 2019. This operation has a high degree of correction. The patella height can be retained as the preoperative height, but the operation is more difficult. In recent years, Ilizarov fifixator [21,22] has been widely used, and its advantages can gradually correct deformities in multi-plane deformities and have gained good postoperative results. It is a good choice for correcting the larger Angle of deformity. Meanwhile, the correction is more accurate [19,20]. However, the device is bulky, patients must receive long-term external fixation. Anterolateral proximal tibial opening wedge osteotomy [23] has a significant effect on genu recurvatum with varus deformity. This operation can simultaneously solve the biplanar deformity, but there is a risk of nerve injury of tibial fracture.