Guided Growth for Tibial Recurvatum

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Growth modulation techniques

Background:

• Genu recurvatum, or knee hyperextension, is an uncommon pediatric deformity, often resulting from trauma.
• Traditional correction via osteotomy carries significant risks.
• Sagittal guided growth of the distal femur is effective for knee flexion deformities, but tibial recurvatum requires alternative approaches.

Purpose of the Study:

• To evaluate the efficacy of a posterior 8-plate in correcting tibial recurvatum in children.
• To determine if guided growth can obviate the need for osteotomy in managing this deformity.

Main Methods:

• A retrospective case series involving five pediatric patients (three boys, one girl) with tibial recurvatum.
• Tethering of the posterior proximal tibial physis using a posterior 8-plate.
• Preoperative and follow-up standing radiographs (AP and lateral views) to assess mechanical axis, limb length, and posterior proximal tibial angle (PPTA).

Main Results:

• Guided growth with the posterior 8-plate was well-tolerated, with no surgical complications.
• The posterior proximal tibial angle (PPTA) improved from an average of 106°-117° preoperatively to 84° post-treatment.
• Correction was achieved over an average of 20 months, resolving knee hyperextension and pseudo-laxity, while maintaining equal limb lengths.

Conclusions:

• Posterior 8-plate guided growth is a safe and effective method for correcting pediatric tibial recurvatum.
• This technique successfully avoids the need for corrective osteotomy in managing genu recurvatum.
• Progressive genu recurvatum in children often presents insidiously, making early intervention with guided growth a viable option.