(a) Better final correction of knee-flexion deformity was obtained in extremities which were not growing. Rapid growth was the chief factor causing a recurrence of the deformity.
(b) A good foot-thrust was important in forcing the knee into extension or recurvatum. Foot-thrust was best when there was an equinus or a strong soleus muscle, without tibial torsion.
(c) Good, lasting correction was obtained by the different methods in the following order: tibial osteotomy (only two cases), open release, supracondylar osteotomy, and stretching.
(d) Functional improvement was obtained in the following order: open release, stretching, supracondylar osteotomy, and tibial osteotomy.
2. Open release:
(a) Better anatomical results were obtained by this procedure than by the other methods in corresponding age groups.
(b) The release of posterior capsule, iliotibial band of fascia lata, and biceps tendon was most essential.
(c) Immobilization in recurvatum for twelve weeks was needed in rapidly growing legs, but 180 degrees' extension for six weeks was sufficient in legs having full growth.
(d) Tibial osteotomy in recurvatum produced more recurvatum in the end, but was one cause of apparent subluxation. The other chief cause was rotation of tibia and fibula.
(e) The functional results were better than those in any other series.
3. Supracondylar osteotomy:
(a) Most of the good anatomical results were obtained in those cases in which the knees were thoroughly stretched also.
(b) The anatomical and functional results were not as good as those obtained by open release.
4. Clinical posterior subluxation of the tibia:
This condition, which was only apparent, was uncommon in the supracondylar-osteotomy series, but frequent in the open-release series, in which many patients had tibial osteotomies in recurvatum. This subluxation did not endanger the stability of the knee.
The weight-bearing property of the knee, with a completely or partially paralyzed quadriceps and some hamstring power, depended on: (a) recurvatum, (b) gluteus-maximus power, (c) foot-thrust.
6. Functional result:
The functional result was frequently vitiated by lateral relaxation and strain after supracondylar osteotomy, but rarely after stretching or open release.
(C) 1935 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.