The Journal of Bone and Joint Surgery, Vol 74, Issue 4 577-586, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Proximal osteotomy of the tibia for the treatment of genu recurvatum in adults
A Moroni, V Pezzuto, M Pompili and G Zinghi
Third Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy.
Twenty-seven opening-wedge osteotomies of the proximal part of the tibia
were performed in twenty-five patients who had genu recurvatum. In sixteen
knees, the genu recurvatum was due entirely to osseous deformity. In the
remaining eleven knees, it was due to a combination of osseous and
soft-tissue deformity; in five, the deformity was predominantly osseous and
in six, primarily in the soft tissues (the ligaments and capsule). The
average age of the patients was twenty-three years (range, fifteen to
fifty-four years). The osteotomy was proximal to the tibial tuberosity in
twenty-two knees. In eighteen of these knees, the tuberosity was detached
with its patellar ligament and then reattached to the proximal part of the
tibia over the block of bone in the opened wedge; in the remaining four
knees, the tibial tuberosity was not detached. The osteotomy was distal to
the tuberosity in five knees. The patients were followed for an average of
14.5 years (range, three to thirty years). Of the eighteen knees in which
the osteotomy had been proximal to the tibial tuberosity and the tuberosity
had been detached and then reattached, nine (50 per cent) had a result that
was excellent; five (28 per cent), good; and four (22 per cent), fair. Of
the four knees in which the operation had been proximal to but without
detachment of the tuberosity, one had a result that was excellent; two,
good; and one, fair. Of the five knees in which the osteotomy was distal to
the tibial tuberosity, one had a result that was good; three, fair; and
one, poor. Of the twenty-one knees in which the deformity was entirely or
predominantly osseous, eighteen (86 per cent) had an excellent or good
result. None of the six knees in which the deformity was predominantly in
the soft tissues had an excellent or good result. Patients in whom the
deformity was not primarily osseous, and those in whom the operation was
distal to the tibial tubercle, were much more likely to have a fair or poor
result.
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