The genu recurvatum is a misalignment 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 bent back. Accordingly, the term genu recurvatum denotes a malalignment in the knee joint that is characterized by hyperextension. It is particularly noticeable when walking, when the affected leg is loaded in the standing leg phase. Normally, true extension of the knee is not possible in most adults.
You just reach the zero position. With a genu recurvatum, hyperextension of ten to fifteen degrees Celsius or more is reached. The extension in the knee joint is limited physiologically by connective tissue structures. The collateral ligaments and the posterior cruciate ligament play a part in this. Above all, however, it is the joint capsule, which is reinforced in the rear area, that stops further movement.
With simultaneous flexion in the hip joint, the hamstring muscles prevent the zero position from being reached when their elasticity is reduced. The muscles that stabilize the joints take over muscular control while standing and walking. 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 various causes, but all of them ultimately lead to connective tissue being overstretched and losing its limiting function. A slight overstretching can result from a genetically predisposed weakness of the connective tissue. In this case it is kept within limits because the controlling muscular system is working.
Severe hypermobility in the knee results from incomplete or complete paralysis of the muscles that ensure the stability of the knee, especially of the quadriceps femoris muscle. The stance and the weight-bearing phases when walking can no longer or only partially be held with the muscles. The joint is brought into the hyperextended position because the bones and connective tissue structures give it support there.
Flaccid paralysis of the leg muscles can occur as a result of a spinal cord injury with a paraplegic problem or as part of poliomyelitis. These diseases usually not only affect the knee muscles. Isolated paralysis of the quadriceps femoris muscle can be caused by injuries in the pelvic area, surgical errors or by herniated discs at the level of segments L2 – L4. A tibial head fracture that has healed in a malposition can also lead to a genu recurvatum.
Symptoms, ailments & signs
The first sign that indicates a genu recurvatum is the visual impression that is created especially when looking at the bare legs while standing or walking. In the case of a one-sided misalignment, this feature is even more noticeable because the gait becomes asymmetrical. Pain can arise where tissue is overloaded by pressure or tension. This initially affects the overstretched structures in the hollow of the knee.
The dorsal capsule shell and the soft tissues in this area are put under enormous tension with every step and when standing and react very painfully. Over time, a habituation effect occurs, which shifts the pain intensity into a tolerable range.
The two joint partners of the knee joint have to withstand more pressure than normal during the genu recurvatum. This is because the two bones are in an awkward position in relation to one another, in which the pressure is distributed over a small area. If the articular cartilage no longer offers enough protection, this leads to pain in the bone.
Diagnosis & course
The diagnosis of the genu recurvatum is primarily based on the clinical examination. The inspection while standing and walking, joint measurements and tests of joint stability usually give the doctor enough information to make a diagnosis. X-rays can be used as a diagnostic tool if bone involvement is suspected.
A genu recurvatum develops gradually because the limiting connective tissue gives way only slowly. The severity depends on the causative factors, especially on whether the stabilizing muscles are still working or not. As a result of the misalignment, osteoarthritis of the knee (gonarthrosis) can develop.
Complications
The genu recurvatum severely restricts the patient’s movement. The disease can also be visually recognized relatively quickly and easily, so that treatment can begin early. Likewise, the patient can no longer move symmetrically and may have to rely on a walking aid in order to cope with everyday life.
In addition to the restrictions, there is also severe pain, which can manifest itself in the form of pressure pain or pain at rest. The affected person is no longer able to put strain on his legs and joints, which also greatly reduces the quality of life. As the disease progresses, there is also pain in the bones.
The genu recurvatum can only be treated if there is no paralysis. Treatment is not possible if the patient is paralyzed. This is done symptomatically and aims to reduce movement restrictions and pain. In most cases, there are no further complications. However, not all restrictions can be dealt with without further ado. It is not uncommon for the restrictions in movement to lead to psychological complaints and depression.
When should you go to the doctor?
If the appearance of the knee joint changes, a doctor should be consulted. If, when walking or standing, the knee shows a shape that is very different from that of other people, a doctor should be consulted. If you experience pain or difficulties in locomotion, it is advisable to consult a doctor. If the pain spreads or if it intensifies, a medical evaluation is required.
Before taking any pain medication, it is necessary to consult a doctor to avoid complications or other impairments. If the knee joint is unusually overstretched, it is advisable to have the overstretched examined by a doctor. If the visual changes lead to emotional or mental problems, a doctor should be consulted. A doctor should be consulted in the event of undesirable changes in personality, abnormal behavior or internal restlessness.
If there is a reduction in well-being, a feeling of illness or withdrawal behavior, the person concerned needs help and support. If there are changes in the skin, redness or swelling, this is considered unusual. A doctor’s visit is necessary to find out the causes of the abnormalities. If the usual level of performance drops and sporting activities can no longer be carried out, a visit to the doctor is recommended.
Treatment & Therapy
Conservative treatment of the genu recurvatum consists of a combination of different measures. This includes physiotherapeutic measures, a supply of aids, and the symptomatic administration of medication. The Physiotherapy worked with patients specific strengthening ways to activate the hamstrings so that they can control the strike-through of the knee better.
On the other hand, special attention is paid to training the quadriceps in order to regain better stability control. Methods from electrical stimulation can also be used for support. All of these measures assume that the muscles are still functioning. It is not effective in the case of complete paralysis.
Certain aids can be used to limit the hyperextension of the knee in order to protect the overstretched structures. Splints or orthoses are suitable for this. Prescribing walking aids can be an effective means of maintaining the ability to walk. Depending on the severity of the loss of function, crutches, canes or walkers can be used, and in extreme cases a walker.
In the case of severe changes, surgical therapy consists of correcting the axial misalignment by means of an adjustment osteotomy. This operation is very time-consuming and stressful and is only carried out if there is a prospect of functional improvement or if the level of suffering is too great.
Outlook & forecast
The prognosis of the genu recurvatum is unfavorable for patients who are already paralyzed. In this case, sufficient mobility of the knee joint cannot be established. The movement restrictions remain in spite of all efforts.
With an early diagnosis and a quick start of treatment, an improvement of the symptoms can be achieved with various therapeutic and medical possibilities. The prognosis for these patients is much more optimistic. Mobility is trained in exercise units specially tailored to the needs of the patient.
This supports the muscle system and the ability to walk. The aim is to achieve improved functionality and thus to promote the quality of life of the person affected. 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 a surgical procedure often have to face major challenges. An operation with surgical measures is usually seen as a last resort and is only used when all other therapies have been exhausted. Misalignments are corrected in the patient. The process is very complex and involves a lot of effort. If the procedure goes without complications, an overall improvement in symptoms can be observed. However, the healing path is lengthy.
Prevention
Active prevention, which is intended to prevent the development or deterioration of a genu recurvatum, is only possible if the muscle function is at least partially preserved. For people with weak connective tissue, regular training of the muscles involved is a very promising way of improving the position of the joints in the long term.
It is important, however, that strengthening goes hand in hand with training in body awareness. This is the only way to ensure that the muscles that can prevent the genu recurvatum are actually trained in this function.
Aftercare
In most cases, Genu recurvatum does not require any special follow-up care. The affected person is primarily dependent on the direct treatment of this deformity. Self-healing cannot occur, so medical treatment is always necessary. Genu recurvatum does not reduce the life expectancy of the person affected, but the patient’s mobility can be severely affected by this disease.
In most cases, the disease is treated with physical therapy and various medications. Some of the exercises from this therapy can also be performed in your own home, which may speed up healing. When taking medication, care must be taken to ensure that it is taken correctly, and interactions must also be taken into account.
In many cases, those affected by Genu recurvatum depend on the support of their own family and friends to make everyday life easier. Above all, very loving and intensive care of the person affected has a positive effect on the further course of the disease. The use of walking aids can also be helpful.
You can do that yourself
The genu recurvatum goes hand in hand with considerable restrictions of the accustomed mobility for the patients and, apart from the physical suffering, also represents an enormous psychological challenge. Despite the shame about the mostly visible illness, it is important that those affected do not withdraw and continue to socialize care for.
This makes it possible to prevent depression and other psychological complications through the genu recurvatum. Contact with other sick people is also possible, for example in the form of self-help groups, in order to deal with the stress together and thereby lose less quality of life.
At best, each patient finds individual ways of dealing with pain that provide relief from the unpleasant sensations in the affected areas. Pain relieving ointments and baths are possible. In general, it is important that the sick also perform the exercises that the physiotherapist has rehearsed at home. Regular training strengthens the muscles and tendons, so that pain can sometimes subside and the quality of life improves.
In certain cases, walking aids are necessary to move safely despite the genu recurvatum. At home, too, crutches or rollators support mobility and the execution of various household tasks, so that they make everyday life easier.
