Reconstruction of lateral knee joint stability following resection of proximal fibula tumors

Zhao, Shichang; Zhang, Changqing; Zhang, Chunlin

doi:10.3892/etm.2013.1429

Cited by 17 publications

(32 citation statements)

References 20 publications

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“… 1 , 10 In contrast, iatrogenic permanent loss of peroneal nerve function is expected in type II en bloc resection of proximal fibula tumors. 8 In the present study, we found that malignancy rather than en bloc resection was a significant risk factor in the univariate analysis. In the multivariate analysis, neither malignancy nor en bloc resection was an independent risk factor for postoperative peroneal nerve palsy.…”

Section: Discussionsupporting

confidence: 46%

“…Malignant potential, more invasive surgical treatments, huge tumor volumes, and some other factors are considered associated with a poorer prognosis; however, these factors appear to be interactive with one another, and their association with recurrence and postoperative complications have not been fully explored in contemporary studies. 3 , 4 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

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Surgical management of proximal fibular tumors: risk factors for recurrence and complications

et al. 2018

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ObjectivesThe aim of this study was to identify patient- and treatment-specific independent risk factors for the recurrence of proximal fibular tumors and complications of their surgical management.MethodsPatients who underwent surgical treatment of proximal fibular tumors at our institution from 2004 to 2015 were retrospectively reviewed. All patients had a pathologically confirmed diagnosis and were followed up for at least 12 months for recurrence and complications. All patients were evaluated with respect to seven patient-, disease-, and treatment-specific variables.ResultsIn the univariate analysis, peroneal nerve palsy at presentation and malignancy were associated with an increased risk of recurrence, iatrogenic peroneal nerve injury, and wound healing problems. The multivariate analysis showed that peroneal nerve palsy at presentation was an independent risk factor for recurrence and iatrogenic peroneal nerve injury and that malignancy was an independent risk factor for wound healing problems.ConclusionsPeroneal nerve palsy and malignant potential are independent risk factors for complications of surgical treatment of proximal fibular tumors. The recognition of these factors may contribute to proper management and help to prevent recurrence and postoperative complications.

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Section: Discussionsupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Surgical management of proximal fibular tumors: risk factors for recurrence and complications

et al. 2018

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“…On the other hand, Zhao et al compared knee stability and MSTS functional scores of patients who underwent type I and type II en bloc proximal fibula resections. 11 According to their results, in patients who underwent LCL and biceps femoris tendon reconstruction surgery, higher rates of knee stability and MSTS scores were exhibited as compared to patients without reconstruction. Additionally, for type I resections, they reported a higher rate of knee stability in the reconstruction group, while no statistical difference was found for type II resections.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiologic outcomes following resection of primary proximal fibula tumors: Proximal fibula resection outcomes

Arıkan

Mısır

Gur

et al. 2019

J Orthop Surg (Hong Kong)

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Reconstruction of the lateral collateral ligament (LCL) and biceps femoris tendon following proximal fibula resection is controversial. Postoperative knee instability and peroneal nerve dysfunction affect outcome. This study aimed to determine functional, clinical, and radiological outcomes of patients who underwent en bloc proximal fibula resections and to compare clinical and radiological instability rates for primary repair after type I and type II resections. Materials and Methods: Eleven patients with primary tumors of the proximal fibula were included. Musculoskeletal Tumor Society (MSTS) score and Lysholm knee score were used in the evaluation of functional outcomes. Clinical outcome was assessed using knee range of motion and knee varus stress test. Radiological outcome was assessed using varus stress knee radiographs. Knee stability was evaluated using the varus stress test at 30 of knee flexion and varus stress knee radiographs and graded in millimeters. Results: Of the 11 tumors, 6 (54.6%) underwent type I resection. In five (45.4%) patients, type II resection was performed. The mean follow-up period was 32 + 13.9 months (range, 12-55 months; median, 27 months). The mean knee joint lateral opening, MSTS score, and Lysholm knee score with type I versus type II resection were 5.7 + 1.2 mm versus 6.4 + 1.1 mm (p ¼ 0.247), 28.7 + 1.8 (95.6%) versus 20.4 + 7.7 (68%) (p ¼ 0.011), and 92.2 + 8.8 versus 62.8 + 20.4 (p ¼ 0.026), respectively. Postoperative complications of all patients included one (9.1%) deep tissue infection and one (9.1%) long-term knee instability. In one patient (9.1%) who underwent type II resection, above-the-knee amputation was performed after local recurrence. Conclusions: Primary repair of the LCL and biceps femoris tendon to the surrounding soft tissues after resection of proximal fibular tumors provides good clinical outcomes. Primary repair is a simple technique to perform with minimal morbidity. Peroneal nerve palsy was a problem, especially in type II resections.

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“…Although stability is not much disturbed even without reconstruction 19 but some studies recommend that the reconstruction of this ligament adds to the stability of the knee. 20 21 …”

Section: Discussionmentioning

confidence: 99%

Fibulectomy for Primary Proximal Fibular Bone Tumors

Kundu

Tanwar

Rana

et al. 2018

IJOO

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Background:Primary benign and malignant tumors of the proximal fibula are not very common. Upper fibula being an expendable bone; the majority of the primary bone tumors at this site are usually treated with en bloc proximal fibulectomy. There is scarce literature on functional results, difficulties faced during dissection when to preserve or sacrifice common peroneal nerve and importance of lateral collateral ligament repair after proximal fibulectomy. The present study attempts at assessing these variables.Materials and Methods:This retrospective study included 46 patients; 30 males and 16 females with age ranging from 12 to 44 years (average: 26 years) operated between 2003 and 2014. There were 34 benign and 12 malignant tumors. All were treated with proximal en bloc fibulectomy as indicated and decided by the operating surgeon keeping in view its extent on magnetic resonance imaging. Peroneal nerve sacrifice or preservation was decided as per the type (benign/malignant), its involvement by the tumor and the extent of the tumor. In 14 (for 12 malignant and two benign giant cell tumors [GCTs]) patients, the peroneal nerve required resection for the margins. Partial upper tibial resection was performed in cases of malignant tumors and three GCTs. The followup ranged between 24 and 120 months (median: 48 months).Results:Patients with peroneal nerve resection had inferior functional outcome than those without peroneal nerve resection. There was no higher risk of tibia fracture in patients with partial tibial resection. Lateral collateral reconstruction yielded better results and should be performed in all cases. Functional outcome was significantly better in patients with benign tumors than in patients with malignant tumors as these required neither resection of the peroneal nerve nor large amount of muscle excision. The functional results were evaluated using Musculoskeletal Tumor Society (MSTS) score, and clinical outcomes were evaluated using knee and ankle movements and stability. The overall average MSTS score was 26.50.Conclusions:With good reconstruction of lateral ligament we can achieve good results after proximal fibulectomy for benign as well as malignant tumor without much instability. With partial upper tibial resection (i.e., the extra-articular resection of proximal tibiofibular joint) adequate margins are feasible even in malignant tumors.

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Reconstruction of lateral knee joint stability following resection of proximal fibula tumors

Cited by 17 publications

References 20 publications

Surgical management of proximal fibular tumors: risk factors for recurrence and complications

Surgical management of proximal fibular tumors: risk factors for recurrence and complications

Clinical and radiologic outcomes following resection of primary proximal fibula tumors: Proximal fibula resection outcomes

Fibulectomy for Primary Proximal Fibular Bone Tumors

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