Background: Symptomatic genu recurvatum is a challenging condition to treat. Both osseous and soft tissue treatment options have been reported to address symptomatic genu recurvatum. Purpose/Hypothesis: The purpose of this article was to review the current literature on surgical treatment options for symptomatic genu recurvatum and to describe the associated clinical outcomes. We hypothesized that anterior opening-wedge proximal tibial osteotomy (PTO) would be the most common surgical technique described in the literature and that this intervention would allow for successful long-term management of symptomatic genu recurvatum. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with the inclusion criterion of surgical treatment options for symptomatic genu recurvatum. Recurvatum secondary to polio, cerebrovascular accident, or cerebral palsy was excluded from this review. Results: A total of 311 studies were identified, of which 6 studies with a total of 80 patients met the inclusion criteria. Causes of genu recurvatum included physeal arrest; soft tissue laxity; and complications related to fractures, such as prolonged immobilization and malalignment. Mean follow-up times ranged from 1 to 14.5 years postoperatively. There were 5 studies that described anterior opening-wedge PTO, 2 of which used the Ilizarov distraction technique. All 3 studies that used PTO without the Ilizarov technique reported correction of recurvatum and increased posterior tibial slope; 2 of these studies also included subjective outcomes scores, reporting good or excellent outcomes in 70% (21/30) of patients. Of the studies that used the Ilizarov technique, both reported correction of recurvatum and increased posterior slope from preoperative to postoperative assessments. Both of these studies reported good or excellent subjective outcomes postoperatively in 89.5% (17/19) of patients. Additionally, 1 study successfully corrected recurvatum by performing a retensioning of the posterior capsule to address knee hyperextension, although follow-up was limited to 1 year postoperatively. Conclusion: Anterior opening-wedge PTO, with or without postoperative external fixation with progressive distraction, was found to be a reliable surgical treatment for symptomatic genu recurvatum. After surgical management with PTO, patients can expect to achieve correction of knee hyperextension, restoration of a more posterior tibial slope, and increased subjective outcome scores.

Purpose The purpose of this study was to compare alignment measured on standard anteroposterior (AP) radiographs versus full-length weight-bearing radiographs. Methods Patients were prospectively enrolled from June 2019 to August 2019 from a single orthopedic surgeon’s practice if they were ≥ 18 years of age, obtained both AP and full-length alignment radiographs and were capable of full weight-bearing with appropriate positioning. Patients were excluded if they were < 18 years of age, had previous knee arthroplasty, previous knee or hip osteotomy, were unable to bear full weight on both limbs, and if the patient’s body habitus precluded appropriate visualization of necessary landmarks on the radiographs. Tibiofemoral angles were measured on AP radiographs using 2 techniques (AP angles 1 and 2). Linear regression and paired t tests were used to compare measurements. The minimal clinically important difference was defined as < 2°. Results There were 120 patients (62 males, 58 females) with an average age of 45 ± 17 years who were enrolled. There were positive correlations between average alignment on full-length weight-bearing and AP radiographs for AP angle 1 ( r = 0.72) and AP angle 2 ( r = 0.76) measurement techniques ( P < .001). There was a significant difference in mean alignment between full-length weight-bearing and AP measurements (AP angle 1: 2.5° difference; AP angle 2: 4.4° difference; P < .001). Frequency distributions for the minimal clinically important difference between true mechanical alignment and AP views demonstrated that 46.7% of patients had ≥ 2° difference for AP angle 1, and 78.3% of patients had ≥ 2° difference for AP angle 2. Conclusion The average absolute difference in alignment measured between standard AP radiograph and full-length weight-bearing radiograph views was significant, with 46.7% to 78.3% of patients having a greater than 2° absolute difference between these 2 views. In cases where precise objective alignment measurement is necessary, full-length weight-bearing radiographs are recommended over standard AP radiographs for presurgical planning so as to reduce potential error in over- or underestimation of the true mechanical alignment. Study Design Prospective case-comparison; Level of evidence, 1.

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.