Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement

Bickels, Jacob; Wittig, James C.; Kollender, Yehuda; Neff, Robert S.; Kellar-Graney, Kristen; Meller, Isaac; Malawer, Martin M.

doi:10.1054/arth.2001.25502

Cited by 108 publications

(137 citation statements)

References 23 publications

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“…Biau et al [4] studied 26 patients with allograft-prosthetic components and found a mean extensor lag of 7.7°. However, comparing our results with those from other series [5,22,38] using medial gastrocnemius flap reconstructions, we observed a slightly better outcome in our patients. Bickels et al [5], for example, reviewed 55 patients during a 20-year period and found full extension to an extension lag of 20°in 44 (78%) patients, an extensor lag of 20°to 30°in 10 (19%) patients, and one greater than 40°in one (3%) patient.…”

Section: Discussionsupporting

confidence: 71%

“…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].…”

Section: Discussionmentioning

confidence: 95%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…At this location, the patellar tendon often has to be resected together with the tumor [5,24,37]. Many patients with musculoskeletal tumors are young and active, and high cure rates have been reported as a result of the steadily increasing success of chemotherapy after its introduction in the late 1970s [15].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

Jentzsch

Erschbamer

Seeli

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several methods are available. A medial gastrocnemius flap commonly is used, although it may be associated with an extensor lag. This problem also is encountered, although perhaps to a lesser extent, with other techniques for reconstruction of the extensor apparatus. It is not known how such lag develops with time and how it correlates with functional outcome. Questions/purposes We therefore (1) assessed patellar height with time, (2) correlated patellar height with function using the Musculoskeletal Tumor Society (MSTS) score, and (3) correlated patellar height with range of motion (ROM) after medial gastrocnemius flap reconstruction. Methods Sixteen patients underwent tumor endoprosthesis implantation and extensor apparatus reconstruction between 1997 and 2009 using a medial gastrocnemius flap after sarcoma resection of the proximal tibia. These patients represented 100% of the population for whom we performed extensor mechanism reconstructions during that time. The minimum followup was 2 years (mean, 5 years; range, 2-11 years). Fourteen patients were alive at the time of this study. We used the Blackburne-Peel Index to follow patellar height radiographically with time. Functional outcomes were assessed retrospectively using the MSTS, and ROM was evaluated through active extensor lag and flexion. Results Eleven patients had patella alta develop, whereby the maximal patellar height was reached after a mean of 2 years and then stabilized. More normal patellar height was associated with better functional scores, a smaller extensor lag, but less flexion; the mean extensor lag (and flexion) of patients with patella alta was 17°(and 94°) compared with only 4°(and 77°) without. Conclusions In our patients patella alta evolved during the first 2 postoperative years. Patella alta is associated with extensor lag, greater flexion, and worse MSTS scores.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

Jentzsch

Erschbamer

Seeli

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Proximal tibial resections and reconstructions: Clinical outcome of 225 patients

Mavrogenis

Pala

Angelini

et al. 2012

Journal of Surgical Oncology

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Biological reconstruction after resection of bone tumors of the proximal tibia using allograft shell and intramedullary free vascularized fibular graft: Long‐term results

Innocenti¹,

Abed

Beltrami³

et al. 2009

Microsurgery

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Reconstruction after excision of bone tumor of the proximal tibia is a challenging issue for the reconstructive surgeon. The combined use of a free fibular flap and allograft can provide a reliable reconstructive option in this location. This article describes the authors' long-term follow-up using this technique. Twenty-seven patients that had resection of proximal tibia bone tumors underwent reconstruction using this technique. Only 21 patients that had primary reconstruction were included in this study. All patients had their surgeries performed at least 24 months before the end of the study. The average age at time of operation was 18.1 years. The average follow-up time was 139.3 months. Limb salvage was 82.7%. The average length of the resected tibial segment was 15.3 cm and that of the residual proximal tibia remaining after resection was 2.7 cm. The average time of union of fibula was 5.4 months and for union of allograft was 19.1 months. Primary union of the allograft was achieved in 90.5% of cases. Full weight-bearing was achieved at an average of 21.6 months. Ten patients (47.6%) had 14 local complications. The (MTSRS) average score at final follow-up was 27.3. Local recurrences occurred in two patients (9.5%). Distant metastasis to the lung occurred in three patients (14.3%). One patient died of disease. This technique provides good long-term results in reconstruction of proximal tibia. The viability of the fibula is a cornerstone in both success of reconstruction as well as successful management of complications.

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Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement

Cited by 108 publications

References 23 publications

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

Proximal tibial resections and reconstructions: Clinical outcome of 225 patients

Biological reconstruction after resection of bone tumors of the proximal tibia using allograft shell and intramedullary free vascularized fibular graft: Long‐term results

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