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Recurvation – Causes, Symptoms and Treatment

Recurvation refers to an excessive backward bending of a joint beyond its normal range, most commonly affecting the knee. It can be congenital or caused by injury.

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Things worth knowing about "Recurvation"

Recurvation refers to an excessive backward bending of a joint beyond its normal range, most commonly affecting the knee. It can be congenital or caused by injury.

What is Recurvation?

Recurvation (from Latin recurvare = to bend back) describes a pathological or excessive hyperextension of a joint beyond its normal straight position. The condition most frequently affects the knee joint, where it is known as genu recurvatum in orthopaedic medicine. Less commonly, recurvation occurs at other joints such as the elbow or along the spine.

Causes

Recurvation can result from a variety of causes, broadly divided into congenital and acquired forms:

Congenital causes: Genetically determined connective tissue weakness, intrauterine malpositioning, or developmental disorders of joint structures.
Traumatic causes: Ligament injuries (e.g., anterior cruciate ligament rupture), fractures with malunion, or growth plate disturbances in childhood.
Neurological causes: Muscle weakness or paralysis (e.g., in cerebral palsy, poliomyelitis, or stroke) reduces muscular control and promotes hyperextension of the joint.
Ligamentous hypermobility: General over-flexibility of the ligaments, as seen in conditions such as Marfan syndrome or Ehlers-Danlos syndrome.
Inflammatory conditions: Chronic joint inflammation such as rheumatoid arthritis can progressively damage the stabilising structures of the joint.

Symptoms

The clinical presentation depends on the degree of hyperextension and the underlying cause:

Visible backward bending of the affected joint during standing or walking
Feeling of instability or pain in the joint
Premature fatigue of the surrounding musculature
Altered gait pattern (particularly in knee recurvation)
Long-term: cartilage damage and osteoarthritis due to unphysiological loading

Diagnosis

Diagnosis is primarily clinical and is supplemented by imaging studies:

Clinical examination: Assessment of the degree of hyperextension in comparison with the contralateral side and ligament stability testing.
X-ray: Evaluation of bony structures and joint alignment.
MRI (Magnetic Resonance Imaging): Detailed visualisation of ligaments, menisci, and cartilage structures.
Gait analysis: Particularly relevant in neurologically caused recurvation for planning treatment.

Treatment

Therapy is tailored to the severity of the recurvation and its underlying cause:

Conservative Treatment

Physiotherapy: Targeted strengthening of the joint-stabilising muscles (e.g., quadriceps, hamstrings) and proprioceptive training.
Orthoses: Specialised knee braces or splints to limit hyperextension during daily activities.
Gait training: Re-education of a physiological gait pattern, especially important in neurological cases.

Surgical Treatment

In cases with structural causes (e.g., ligament insufficiency or bony malalignment), surgical intervention may be required, such as ligament reconstruction or corrective osteotomy (a bone-cutting procedure to correct the joint axis).

References

Niethard, F. U., Pfeil, J., Biberthaler, P. (2014). Duale Reihe Orthopaedie und Unfallchirurgie. Thieme Verlag, Stuttgart.
Moreland, J. R. et al. (1987). Genu recurvatum in neuromuscular disease. Journal of Bone and Joint Surgery, 69(5), 756-761.
Stief, F. et al. (2011). Gait analysis in patients with genu recurvatum. Gait and Posture, 33(3), 357-362.

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