Protecting a Patellar Ligament Reconstruction after Proximal Tibial Resection: A Simplified Approach

Abstract

Limb salvage in tumor surgery has encouraged the development of megaprostheses. However, reattaching the ligamentum patellae poses a particular problem: avulsion and/or extensor lag may lead to poor function. We describe a new technique of patellar ligament reconstruction. The technique involves reattachment of the patellar ligament to the tibial tuberosity of the proximal tibial megaprosthesis, which has a porous surface created, and the repair is protected with a cerclage wire through the patella and the prosthesis. In 10 consecutive patients, the range of motion averaged 95°(median, 90°; range, 70°-120°), and the mean extension lag averaged 4°(median, 0°; range, 0°-20°). We had one case of patellar ligament avulsion. This technique resulted in good quadriceps function and a low incidence of complications.

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

“…In addition, this patellar height finding is in contrast to that of normal knee arthroplasties, where patellar tendon length has been reported to decrease [28]. This might be because tendons do not grow on the metal naturally and anchorage might loosen as long as scar formation has not finished [3,5,9,14,20,24,[37][38][39][40][41].…”

“…The mean extensor lag of 50 patients studied by Grimer et al [22] was 30°. When using a medial gastrocnemius flap, there is debate regarding whether to augment the attachment with some kind of synthetic material [3,5,7,9,14,20,24,31,[37][38][39][40][41]. As described, tight fixation during surgery is considered important, and the goal is scarring of the induced membrane around the prosthesis with the remnant patellar tendon and the gastrocnemius flap.…”

“…However, since tendinous tissue does not grow naturally to metal, controversy remains regarding reconstruction techniques for the extensor mechanism [3,5,9,14,20,24,27,[37][38][39][40][41]. Several synthetic devices, such as nonabsorbable tapes, tubes, sutures, cerclage wires, and transplants, such as autograft and allograft from the sartorius or biceps tendons and gastrocnemius flaps have been used [3,5,7,9,14,20,24,31,[37][38][39][40][41].…”

“…Several synthetic devices, such as nonabsorbable tapes, tubes, sutures, cerclage wires, and transplants, such as autograft and allograft from the sartorius or biceps tendons and gastrocnemius flaps have been used [3,5,7,9,14,20,24,31,[37][38][39][40][41]. It has been reported that the patellar ligament stretches after reconstruction with a tumor prostheses and medial gastrocnemius flap, whereas it remains stable when reconstructed with an allograftprosthesis composite [3,37,39]. The patellar height may be measured with various indexes, including the BlackburnePeel index [2,6,8,10,25,28,29,36].…”

Proximaler Tibiaersatz mit Transfer des M. Gastrocnemius

“…Die Entwicklung zur komplikationsärmeren Techniken wurden gezeigt [2,6,10,15,17,21]. Die deutlich geringeren Infektionsraten sind hauptsächlich auf die Einführung der Gastrocnemiusplastik zurückzufüh-ren.…”