Treatment of genu recurvatum by proximal tibial closing-wedge/anterior displacement osteotomy

An operation is described for correction of the osseous form of genu recurvatum, which is secondary to premature closure of the anterior part of the proximal tibial physis with continued growth of the posterior part. At the Alfred I. duPont Institute 14 patients with 17 involved knees have been treated surgically for osseous genu recurvatum. All patients complained of cosmetic deformity, and nine of the 14 had pain. Etiologic factors included immobilization, trauma, and Osgood-Schlatter disease. The average age at surgery was 15 years six months, and the average follow-up period to date has been 20 months. Surgical procedures include the Irwin osteotomy (6 knees), the proximal opening-wedge osteotomy (2 knees), the distal closing-wedge osteotomy (1 knee), and the closing-wedge/anterior displacement osteotomy (8 knees). In all 17 of the knees in this series symptoms resolved following surgery, and 16 knees were stable at clinical examination. The closing-wedge/anterior displacement osteotomy has the advantages of rapid healing, good correction of the deformity, restoration of the depressed tibial tubercle, fewer complications, and resection of the remaining physis, which prevents recurrence.