A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum: Posterior Oblique Ligament Advancement

Genu recurvatum is a challenging disorder and can negatively affect knee biomechanics, as reflected in its role as a risk factor for knee ligament injury and poor outcomes following ligament reconstruction or arthroplasty.

Pathological recurvatum should be addressed in the presence of a causative correctible structural abnormality, whether due to decreased posterior tibial slope or due to multiligament injury. We described a posterior oblique ligament (POL) advancement technique for the treatment of knee recurvatum.

After completion of all concomitant procedures such as ligament reconstructions, the procedure is initiated with a medial approach. The POL is isolated with an inverted L-shaped dissection and mobilized. Mattress sutures are passed through the resulting POL flap, and are re-tensioned and fixed anteriorly and distally, with the knee close to extension, in order for the imbrication to restrain hyperextension.

Anecdotal evidence points to satisfactory control of knee recurvatum postoperatively, which can potentially avoid its deleterious effects in surgical outcomes.

We present a promising option in the treatment of pathological recurvatum, with favorable cost-efficacy, low morbidity relative to slope-altering osteotomy or posterolateral soft tissue procedures, and focused on the biomechanically demonstrated main restrictors to knee hyperextension.

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