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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 83-85 |
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A new approach for the management of knee hyperextension in pediatric cases: Modified knee hyperextension orthosis
Gouri RajendraKumar Chechani1, Sahil Patel2
1 Department of Prosthetic and Orthotic (BPO Section), National Institute for the Locomotor Disabilities, Kolkata, West Bengal, India
2 Department of Prosthetic and Orthotic, Sumandeep Vidyapith Deemed to be University, Piparia, Waghodia Vadodara, Gujarat, India
| Date of Submission | 28-Dec-2022 |
| Date of Decision | 07-Jan-2023 |
| Date of Acceptance | 16-Jan-2023 |
| Date of Web Publication | 16-May-2023 |
Correspondence Address:
Dr. Gouri RajendraKumar Chechani
Department of Prosthetic and Orthotic, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Vadodara, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jihs.jihs_24_22
Background: Knee hyperextension can be a serious and disabling injury in both the athletic and general patient population. The flexible type of knee hyperextension can be controlled by either static or dynamic knee orthosis. An important aspect of patient care in knee hyperextension is the application of proper knee orthosis. Knee orthosis is a nonoperative method for the management of knee hyperextension. It is a challenging task in this new engineering field of orthotic science for the orthotist to design suitable orthosis for knee hyperextension. The modern method of orthotic technology needs changes to benefit patients with knee hyperextension to fulfill the functional need for the user. A knee orthosis should, hypothetically, allow full range of motion, except it limits where there will be orthotic constraints. This knee orthosis is a modified polypropylene knee hyperextension orthosis for nonoperative management of knee hyperextension. Aims and Objective of the Study: The purpose of the design is to provide a nonoperative solution to control knee hyperextension in pediatrics for the prevention of knee structures by changing the line of force. Materials and Methods: It is a custom-made orthosis made of polymer sheet with a hinged knee joint with thigh shell and leg shell placed in the contralateral side and provides a rigid support for the knee without hindering knee flexion with full restriction of knee hyperextension. There will be no suprapatellar protrusion like the one conventional plastic supracondylar knee orthosis. Results: Based on observational gait analysis, molded polypropylene knee hyperextension orthosis provides a stable gait pattern with a minute or no gait deviation from the normal gait parameters (gait parameters varies between different subjects). Conclusions: A technique has been proposed for the management of genu recurvatum. A theoretical and practical justification for the method has been presented, and a thorough analysis is required. The use of modified knee orthosis appears to give protection against the anterior tibial translation, thus preventing hyperextension and gives a better gait with the help of initial flexion angle.
Keywords: Genu recurvatum, hinge knee joint, modified knee orthoses, prevention
How to cite this article:
Chechani GR, Patel S. A new approach for the management of knee hyperextension in pediatric cases: Modified knee hyperextension orthosis. J Integr Health Sci 2022;10:83-5 |
How to cite this URL:
Chechani GR, Patel S. A new approach for the management of knee hyperextension in pediatric cases: Modified knee hyperextension orthosis. J Integr Health Sci [serial online] 2022 [cited 2023 Jun 2];10:83-5. Available from: https://www.jihs.in/text.asp?2022/10/2/83/377150 |
| Introduction | |  |
The knee joint is the joint between the femur and tibia, is the largest joint in the body, and is the most vulnerable to injury.[1],[2] Genu recurvatum or hyperextension of the knee is a sagittal plane deformity [Figure 1] and occurs in the stance phase of the gait cycle. The knee joint is supposed to bear the weight of the body. In normal extended knee posture, the line of gravity passes posterior to the knee joint and tends to flex the knee, which is counteracted by the knee extensors and the knee joint structures. In hyperextended knee position the line of gravity passes considerably anterior to knee joint axis. This causes an increased gravitational moment at the knee joint and tend to increase the hyperextension deviation. In this position the posterior knee joint capsule lies under considerable tension stress.[3],[4] A continual adaptation of this posture results in adaptive lengthening of the posterior capsule and the anterior joint surfaces of the femoral condyles and the anterior portion of the tibial plateaus are subjected to abnormal compression and degenerative changes of the cartilaginous joint surfaces.[5],[6] Hence, knee hyperextension in early childhood is more dangerous for future knees if not treated on time. McCaughan D et al. found in their study that in knee hyperextension orthotic devices play a crucial role in increasing balance and stability.[7]
Here, a new approach has been made to control genu recurvatum in the case of children with a custom-molded polypropylene knee orthosis which is dynamic and functional in nature and controls the hyperextension of the knee very efficiently without obstructing the normal knee joint range of motion. The purpose of the orthosis is to hold the limb in certain degrees of flexion, to force the line of gravity to pass behind the knee joint and thus preventing the hyperextension of the knee.[8],[9],[10]
| Materials and Methods | | |
Five patients with genu recurvatum have been fitted with this polypropylene orthosis between June 2008 and June 2009.[11] Before fitting the orthosis, patients were assessed thoroughly. Patients were asked to lie down in side-lying position, and the knee was kept in 5°–7° of flexion for the initial stretch of quadriceps muscle. Casting and modification are done as the standard way of knee brace.[12] Two flat buildups were made on either side of the knee joint covering the upper border of the knee [Figure 2]. Molding was done in two stages with polypropylene.[10] In the first stage, the posterior thigh shell was molded and trimmed covering posterior half of the thigh. On the distal aspect, the thigh shell covered the knee joint. Superiorly, it extended up to half an inch distal to the groin. Trim line in the posterior-inferior aspect was made keeping in mind of complete knee flexion. The distolateral region covers up to the lower level of the knee joint. After trimming, the thigh shell was placed over the mold. In the second stage, the anterior thigh shell was made, covering the distal portion of the thigh shell and half of the patella. Appropriate pressure was applied over either side of the knee region to make a groove. The leg portion was trimmed, covering the anterior half of the leg; inferiorly, it extends up to the equal length of the thigh shell providing free ankle motion [Figure 3]. Both the thigh and leg shells were attached together with free motion joint [Figure 4]. Groove made on the proximal part of the orthosis creates an obstruction to control the flexible type of genu recurvatum [Figure 5]. The following conditions were to be considered while fabricating this orthosis as it is made of polypropylene, and joint is not sturdy enough to bear large recurvatum forces: | Figure 4: Side view of incorporated joint in the design to control hyperextend of knee
Click here to view |
- Congenital genu recurvatum
- Complex instabilities due to genu recurvatum
- Flexible type of genu recurvatum that is the absence of quadriceps contractures
- After injuries of the cruciate ligaments
- Postoperative stabilization of knee joint.
| Results | | |
Patients, when wearing modified hyperextension knee orthosis, provide a stable gait pattern with a minute or no gait deviation compared to those without orthosis (gait parameters vary between different subjects). Results are based on observation only.
| Discussion | | |
Based on observational gait analysis, patients having genu recurvatum without any orthosis walk with a very unbalance and improper gait pattern due to the posterior subluxation of the knee joint at the time of full weight bearing.[5],[3]
Patients wearing a knee orthosis without any joint or drop-lock type of knee joint lacks in knee flexion required at the time of the gait cycle, thus increasing the energy expenditure and creating deviation from the normal gait cycle.
Studies also show that keeping the knee in proper alignment in children also helps in proprioception and better development of gross motor skills.[9] The orthosis fits the contours of the thigh and leg without any protrusion while standing or sitting, providing a snug fitting.[10] This is an added advantage over currently available polypropylene knee orthosis. The orthosis does not provide any concentrated pressure over the popliteal region. There is also no chance of slippage using this orthosis. It is very light in weight and also can be used bilaterally because of its narrow and intimate fit. As the design is tried on the subjects of 3–5year old children's, we face difficulty to take countable data for gait and other parameters.
Consumers enjoyed comfortable sitting while using knee orthoses. Other activities, which included active knee flexion, were found satisfactory.
| Conclusions | | |
To prevent genu recurvatum, modified knee hyperextension orthosis should be provided at a very early stage.
Although the orthotic design provides better results pediatric cases, revised follow-up is necessary for detailed gait analysis and effectiveness.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Datta AK. Essentials of human anatomy: Superior and inferior extremities. Current books international; Kolkata, India. 2009. c (25) p. 232-50.  |
| 2. | Chaurasia BD. Back of the thigh: Human anatomy regional and applied dissection and clinical volume 2 lower limb, abdomen and pelvis., C (12) p. 143-52. |
| 3. | Jacquelin Perry MD. Gait analysis: Normal and pathological function. New Jersey: SLACK. 2010. |
| 4. | Geerars M, Minnaar-van der Feen N, Huisstede BM. Treatment of knee hyperextension in post-stroke gait. A systematic review. Gait & Posture 2022;91:137-48. |
| 5. | Pamela K, Levangie C. C Norkin. Joint Structure & Function, A Comprehensive Analysis, 3 rd edition: Jaypee Brothers: New Delhi 2001:C (11);326-63. |
| 6. | Fuss FK. The restraining function of the cruciate ligaments on hyperextension and hyperflexion of the human knee joint. The Anatomical Record 1991;230:283-9. |
| 7. | McCaughan D, Booth A, Jackson C, Lalor S, Ramdharry G, O'Connor RJ, et al. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: Qualitative interview study of patient perspectives. BMJ open 2019;9:e029313. |
| 8. | Hsu JD, Michael JW, Fisk JR. AAOS Atlas of Orthoses and Assistive Devices. 2 nd ed. JD Hsu, JW Michael, JR Fisk - journals.lww.com, Dallas Texas; 2009. |
| 9. | Parent-Nichols J, Chamberlain D. Use of a knee orthosis to advance motor control in a 3-year-old with achondroplasia: A case report. J Prosthet Orthot 2022;34:e61-8. |
| 10. | Dixon M, Palumbo R. Polypropylene knee orthosis with suprapatellar latex strap. Orthotics and Prosthetics 1975;29:29. |
| 11. | Noyes FR, Dunworth LA, Andriacchi TP, Andrews M, Hewett TE. Knee Hyperextension Galt Abnormalities in Unstable Knees: Recognition and Preoperative Gait Retraining. The American Journal of Sports Medicine 1996;24:35-45. |
| 12. | Behera M, Jacob F. Effectiveness of modified dual axis knee brace in case of genu recurvatum – A case report. Int J Health Sci Res 2020;10:239-43. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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