Extra-articular wide tumor resection and limb reconstruction in malignant bone tumors invading the knee joint

Surgical Technique: Extraarticular Knee Resection with Prosthesis-Proximal Tibia-extensor Apparatus Allograft for Tumors Invading the Knee

“…First, as with the other series, we had a small number of patients, although relatively large compared with numbers in the other studies. The indication for extraarticular resection of the knee is rare and studies describing this kind of surgery combined with a functional reconstruction include between nine and 13 patients [2,[12][13][14][15]20]. Second, our series of tumors was heterogeneous for type, stage, and adjuvant treatment.…”

“…To maintain active knee extension, some authors have advocated a resection that spares part of the extensor apparatus by splitting the patella, and preservation of the patellar and quadriceps tendons [12][13][14][15]20]. Reconstruction then can be performed with an osteoarticular whole knee allograft [13], a megaprosthesis [12,15,20], or an allograft-prosthetic composite [14].…”

“…The second technique is a classic extraarticular resection including en bloc removal of the extensor apparatus and its reconstruction with a pedicled medial gastrocnemius muscle flap [2,12]. The literature suggests active extension is quite variable with this approach and extensor lags reportedly range from 0°to 70° [2,12,15,20].…”

“…The first technique consists of a limited extraarticular resection with preservation of the extensor mechanism. This approach requires vertical splitting of the patella in the frontal plane and detaching the suprapatellar synovial pouch and infrapatellar fat pad from the quadriceps and patellar tendon [12][13][14][15]20]. Achieving wide surgical margins may be difficult or in some cases even impossible with this approach.…”

“…Reconstruction after extraarticular knee resection can be accomplished with an arthrodesis [4,7,17,18] or with jointfunction-preserving procedures [2,[12][13][14][15]20]. Two techniques have been proposed for the latter option.…”