124. CONGENITAL GENU RECURVATUM IN CHILDREN

Abstract

Purpose of the study: The anatomic, clinical and radiographic expression of congenital genu recurvatum corresponds to femorotibial subluxation. The clinical presentation can vary, ranging from an easily reducible subluxation to irreducible dislocation.

Material and methods: Fifty five patients (82 knees) were treated, mean age 2 days. Genu recurvatum was isolated (n=15 children), associated with hip dislocation or foot deformity (n=40 children), arthrogyrposis (n=10 children, or Larsen syndrome (n=3 patients). Were studied: anterior skin folds, anteroposterior femorotibial instability, joint range of motion at first exam and last follow-up. The Seringe classification was noted at birth: I – reducible (n=59 knees), II – difficult to reduce (n=12 knees), III – irreducible (n=11 knees). Mean follow-up was 4 years, 13 years, and 9 years for class I, II and III knees respectively. Orthopaedic treatment was performed in all cases with manipulations, braces, traction and plaster cast for at least 40 days. In the event of failure, a V/Y lengthening of the quadriceps was performed, associated with joint release.

Results: At the first exam, the skin folds were present in all cases in group I, 2/3 in group II, and absent in group III. Mean maximal flexion was 66, 43 and 17 respectively in groups I, II and III. The even operated knees were in group III. At last follow-up, the mean maximal flexion was 146, 124 and 77 respectively in groups I, II and III. Six knees presented anteroposterior instability in groups I, 3 in group II and 3 in group III. In group I, the final clinical outcome was good or very good in 55 knees (93%), fair in 4. In group II, good or very good outcome was noted in 8 knees (67%), fair in 3 (25%), and poor in 1 knee. In group III, outcome was faire in 4 (36%) and poor in 7 (64%). In this group, poor outcome corresponded to 86% of the operated knees.

Discussion: At the first exam, factors having the most unfavourable impact were: absence of an anterior skin fold, knee flexion < 50, irreducible femorotibial dislocation, and syndrome context. We emphasise the importance of adapted conservative treatment which, in our experience, provides the better clinical outcomes.