Treatment Strategies for Genu Recurvatum in Adult Patients With Hemiparesis: A Case Series

Abstract

GR in hemiparesis is multifactorial and can be successfully controlled by using a conservative biomechanical factor-based approach and combined medical and orthotic interventions. An algorithmic approach and a prospective study design is proposed to determine a combination of effective interventions to correct GR.

Control of Stroke-Related Genu Recurvatum With Prolonged Timing of Dorsiflexor Functional Electrical Stimulation: A Case Study

“…1,2 From a biomechanical point of view, it is characterized by a ground reaction force vector anterior to the knee joint center. 1,3,4 Different causal mechanisms that may lead to genu recurvatum have been proposed in the literature, including (i) weakness of quadriceps, hamstrings, or buttock muscles; (ii) spasticity of quadriceps; (iii) limited ankle dorsiflexion during the stance phase; and (iv) proprioceptive disorders. 1 Depending on the identified or suspected cause, different types of treatment have been proposed such as medical therapy (eg, intramuscular injection of botulinum A toxin into triceps surae 5 ), orthotic devices (eg, ankle-foot orthoses [AFOs], 6 knee-ankle-foot orthoses 4 ), rehabilitation techniques (eg, feedback electrogoniometric devices or multichannel electrical stimulation 1 ) or surgical procedures (eg, aponeurotic calf muscle lengthening 1 ).…”

“…In situations such as this, AFOs have been shown to be an efficient intervention, correcting both the ankle dorsiflexion at initial contact and the posterior tibial inclination during the stance phase. 3,4,6,8 However, the use of AFOs has been associated with reduced ankle joint mobility and poor muscle activation. 9 Functional electrical stimulation (FES) applied to the peroneal nerve has been proposed as an alternative to AFO for the treatment for impaired ankle dorsiflexion (ie, foot drop).…”

Knee-ankle-foot orthoses for treating posterior knee pain resulting from genu recurvatum: Efficiency, patients' tolerance and satisfaction

“…• a verbal rating scale (VRS), where each response option consisted of descriptions of pain. Scores were attributed to the various responses corresponding to different levels of pain intensity: "no pain" [0], "mild pain" [1], "moderate pain" [2], "severe pain" [3], and "extreme pain" [4] (33).…”

“…G enu recurvatum (GR) is hyperextension of the knee of more than 5°, in which the ground reaction force (GRF) line is anterior to the knee axis (1). GR can occur in various neuromuscular and musculoskeletal diseases, such as myopathy, upper motor neurone diseases, such as stroke, cerebral palsy, multiple sclerosis (2)(3)(4)(5), and lower motor neurone diseases, such as poliomyelitis.…”

Prevention of Genu Recurvatum in Poststroke Patients Using a Hinged Soft Knee Orthosis

“…Additionally, this gait disorder can be painful as a result of stress to the soft tissues at the posterior aspect of the knee [5]. Conventional treatment of genu recurvatum mainly involves exercises for strengthening of the knee and thigh muscles, physical assistance and guidance to the movements of the pelvis, hip, and knee [7], injections for reduction of spasticity [8], and orthotics [9]. An articulated ankle‐foot orthosis (AFO) has been shown to be effective in improving early stance knee moments in poststroke patients with genu recurvatum [10].…”