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Genu Recurvatum – Causes, Symptoms & Treatment

Genu recurvatum is a deformity in which the knee joint hyperextends beyond its normal range. It can be congenital or acquired and is often associated with instability and pain.

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Things worth knowing about "Genu Recurvatum"

Genu recurvatum is a deformity in which the knee joint hyperextends beyond its normal range. It can be congenital or acquired and is often associated with instability and pain.

What is Genu Recurvatum?

Genu recurvatum (Latin: bent-back knee) is a deformity of the knee joint in which the knee hyperextends backward beyond the normal range of motion during standing or walking. Clinically, it is defined as a hyperextension of more than 5 to 10 degrees. The condition can affect one or both knees and occurs in both children and adults.

Causes

The causes of genu recurvatum are diverse and can be divided into congenital and acquired forms:

Congenital causes: Genetic connective tissue weakness, intrauterine malpositioning, or congenital joint laxity (hypermobility)
Neurological conditions: Muscle weakness or paralysis caused by cerebral palsy, poliomyelitis, or myelomeningocele can lead to imbalance of the knee-stabilizing muscles
Traumatic causes: Ligament injuries (especially to the anterior cruciate ligament), growth plate injuries in childhood, or fractures can contribute to hyperextension
Degenerative and inflammatory conditions: Osteoarthritis, rheumatoid arthritis, or other joint diseases can compromise knee stability
Connective tissue disorders: Conditions such as Marfan syndrome or Ehlers-Danlos syndrome are frequently associated with joint hypermobility

Symptoms

The symptoms of genu recurvatum depend on the degree of deformity and the underlying cause. Common symptoms include:

Visible backward bending of the knee during standing or walking
Knee pain, especially after prolonged standing or physical activity
Feeling of instability in the knee joint
Altered or limping gait pattern
Muscle weakness or fatigue in the thigh area
In advanced cases: degenerative changes of the knee joint (gonarthrosis)

Diagnosis

The diagnosis is typically established through a clinical examination. The degree of hyperextension is measured and the stability of the knee ligaments is assessed. The following diagnostic measures may be used:

Clinical examination: Inspection of the leg axis, goniometry (angle measurement), and gait analysis
X-ray imaging: Assessment of bony structures and joint space
MRI (Magnetic Resonance Imaging): Detailed visualization of ligaments, menisci, and cartilage
Neurological examination: When a neuromuscular cause is suspected

Treatment

Treatment depends on the severity of the deformity and its underlying cause:

Conservative Treatment

Physiotherapy: Strengthening of the thigh muscles (particularly the quadriceps femoris), improvement of proprioception, and gait training
Orthoses and braces: Specialized knee orthoses can limit hyperextension and stabilize the joint
Insoles: Custom orthopedic insoles to correct leg axis alignment

Surgical Treatment

In severe or treatment-resistant cases, surgical intervention may be necessary:

Ligament reconstruction: Repair or reconstruction of torn or insufficient knee ligaments
Osteotomy: Corrective bone-cutting procedure to realign the leg axis
Knee replacement (knee prosthesis): In cases of advanced joint destruction

Prognosis

The prognosis of genu recurvatum depends on the underlying cause and the timing of treatment. With early and consistent therapy, many patients can achieve a significant improvement in stability and become pain-free. If left untreated, there is a risk of progressive joint degeneration.

References

Moroni A. et al. - Genu Recurvatum: Pathophysiology and Treatment Options. Journal of Orthopaedic Surgery and Research, 2021.
Staheli L.T. - Fundamentals of Pediatric Orthopedics. Lippincott Williams & Wilkins, 5th Edition, 2016.
World Health Organization (WHO) - International Classification of Functioning, Disability and Health (ICF). WHO Press, Geneva, 2001.

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