Allograft Reconstruction of the Extensor Mechanism after Resection of Soft Tissue Sarcoma

Abstract

Introduction Soft tissue tumors around the knee joint still pose problems for the excision and subsequent reconstruction. Methods In the 6 included patients the soft tissue sarcoma has its base on the anterior surface of the extensor mechanism and expands towards the skin. The entire extensor apparatus (quadriceps tendon, patella, and patellar tendon) was resected and replaced by a fresh-frozen allograft. Results The mean follow-up was 6.7 years (range: 2–12.4 years). In two patients a local recurrence occurred, resulting in a 5-year local recurrence-free rate of 66.7% (95% CI: 19.5%–90.4%). Distant metastases were found in 4 patients resulting in a 5-year metastasis-free rate of 33.3% (95% CI: 4.6%–67.5%). Two patients underwent at least one revision surgery, including one patient in whom the allograft had to be removed. According to the ISOLS function score 24.7 points (range: 19–28 points) were achieved at the last follow-up. The mean active flexion of the knee joint was 82.5° (range: 25–120°) and a mean extension lag of 10° (range: 0–30°) was observed. Conclusions The replacement of the extensor mechanism by an allograft is a reasonable option, allowing wide margins and restoration of active extension in most patients. Trial Registration The presented study is listed on the ISRCTN registry with trial number ISRCTN63060594.

Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature

“…To date, total patellectomies have been reported in treating Campanacci grade III GCTB or malignant neoplasms arising from the patella[ 5 , 6 , 8 , 10 , 16 ]. To repair the consequent defect in the extensor mechanism, several reconstruction methods including end-to-end suture of the quadriceps tendon and patellar tendon[ 6 ], allografting[ 5 , 7 , 8 ], and autografting[ 10 , 11 ] have been proposed. Still, each of them has its demerits (Table 1 )[ 5 , 6 , 17 - 19 ].…”

“…Several methods for the reconstruction of extensor mechanisms have been applied, such as end-to-end suture of the quadriceps tendon and patellar tendon[ 6 ], allografting[ 5 , 7 - 9 ], and autografting[ 10 - 12 ]. Although these procedures have been reported to lead to reasonable functional outcomes, each has its corresponding disadvantages, such as donor site morbidity, extensor lag, disease transmission, and graft rejection.…”

Current Advances on the Regeneration of Musculoskeletal Interfaces

“…Results showed a local tumour recurrence in 33.3% of patients 5 years after surgery; 66.7% of patients showed presence of metastasis and 33.3% of patients needed a revision surgery. The flexion mean of the knee was 82.5° (range: 25-120°) and the mean extension lag was 10° (range 0-30°) 35 , making this approach a reasonable approach for reconstructing the joint. Sicari et al, 2014 performed a clinical trial on musculotendinous tissue repair and its reinforcement by implanting decellularized porcine urinary bladder scaffold in the injury site.…”

“…Further causes of damage to musculoskeletal interfaces are insurgences of tumours of bone, cartilage or soft tissues (sarcoma), due to the invasiveness of necessary resection of the tumour mass 35,36 . Osteosarcoma and soft tissue sarcoma are commonly treated by surgery, followed by chemotherapy or radiotherapy 37,38 .…”

Bilateral Extensor Mechanism Allograft Reconstruction in Native Knees

“…Various reconstructive techniques using synthetic mesh or tendon auto/allograft have been described 18,19 . Complete extensor mechanism allograft reconstruction has been used for complicated scenarios including oncologic treatment 20 and failed knee arthroplasty [21][22][23] with satisfactory results. This case illustrates a staged bilateral complete extensor mechanism allograft reconstruction in the setting of bilateral chronic quadriceps tendon ruptures with profound patella baja.…”