Chou Te-Feng Arthur, An Jae-Sung, Douoguih Wiemi A, Koga Hideyuki, Ollivier Matthieu
MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Orthop J Sports Med. 2025 Aug 5;13(8):23259671251356689. doi: 10.1177/23259671251356689. eCollection 2025 Aug.
Symptomatic genu recurvatum (GR) continues to be a challenge for clinicians. Patients may present with pain, weakness, and instability, which can lead to significant functional impairment. Currently, there are few reports discussing the treatment options and clinical outcomes of patients with symptomatic GR.
PURPOSE/HYPOTHESIS: The main objective of this study was to present the radiographic and functional outcomes of tuberosity-sparing anterior opening-wedge tibial osteotomy (TAOWTO) for symptomatic GR. It was hypothesized that TAOWTO can adequately correct the deformity and allow patients to have symptomatic relief after the procedure without compromising patellofemoral joint function.
Case series. Level of evidence, 4.
This retrospective study was performed at a single, tertiary referral center. All patients underwent a TAOWTO performed by a single surgeon between January 2016 and January 2021. Pre- and postoperative radiographs were analyzed for posterior proximal tibial angle (PPTA), recurvatum angle, pertinent lower extremity alignment parameters, and patellar height. All patients were clinically evaluated pre- and postoperatively for the Knee injury and Osteoarthritis Outcome Score (KOOS).
After exclusions, 30 patients were included in the study. The mean age at the time of surgery was 22.6 ± 3.5 years, and the mean follow-up duration was 25.2 ± 7.8 (median, 35; range, 20.1-27.5) months. The causes of recurvatum were posttraumatic (53.3%), posterior cruciate ligament insufficiency (16.7%), anterior epiphysiodesis (6.7%), and soft tissue laxity (23.3%). The PPTA (in degrees) before and after the surgery was 94.2 ± 2.7 and 85.8 ± 1.8, respectively ( < .0001). There were no significant changes in hip-knee angle, medial proximal tibial angle (in degrees) and Caton-Deschamps index. In addition, the recurvatum angle was significantly reduced (12.0 ± 2.9 vs 2.9 ± 1.7; < .0001). All domains of KOOS (Pain, Symptoms, Activities of Daily Living, Quality of Life, and Sport and Recreation) were significantly improved after the surgery ( < .0001).
TAOWTO was an effective surgical procedure for patients with symptomatic GR. It reliably corrected the PPTA and recurvatum angle, while maintaining the native coronal alignment and patellar height. Patients also had significant symptomatic relief and functional improvement in both daily and sports activities.
有症状的膝反屈（GR）对临床医生来说仍然是一项挑战。患者可能出现疼痛、无力和不稳定，这可能导致严重的功能障碍。目前，很少有报告讨论有症状的GR患者的治疗选择和临床结果。
目的/假设：本研究的主要目的是介绍保留结节的前路开口楔形胫骨截骨术（TAOWTO）治疗有症状的GR的影像学和功能结果。假设TAOWTO可以充分矫正畸形，并使患者在术后症状得到缓解，同时不影响髌股关节功能。
病例系列。证据等级，4级。
这项回顾性研究在一个单一的三级转诊中心进行。2016年1月至2021年1月期间，所有患者均由同一位外科医生进行TAOWTO手术。分析术前和术后的X线片，测量胫骨近端后角（PPTA）、反屈角、相关下肢对线参数和髌骨高度。所有患者在术前和术后均接受膝关节损伤和骨关节炎结果评分（KOOS）的临床评估。
排除后，30例患者纳入研究。手术时的平均年龄为22.6±3.5岁，平均随访时间为25.2±7.8（中位数，35；范围，20.1 - 27.5）个月。膝反屈的原因包括创伤后（53.3%）、后交叉韧带不全（16.7%）、前路骨骺阻滞（6.7%）和软组织松弛（23.3%）。手术前后的PPTA（度数）分别为94.2±2.7和85.8±1.8（P <.0001）。髋膝角、胫骨近端内侧角（度数）和Caton-Deschamps指数无显著变化。此外，反屈角显著减小（12.0±2.9 vs 2.9±1.7；P <.0001）。术后KOOS的所有领域（疼痛、症状、日常生活活动、生活质量以及运动和娱乐）均有显著改善（P <.0001）。
TAOWTO是治疗有症状的GR患者的有效手术方法。它能可靠地矫正PPTA和反屈角，同时保持原有的冠状位对线和髌骨高度。患者在日常和体育活动中的症状也有显著缓解，功能得到改善。
