The role of mesh technology with tumor prosthesis reconstruction to reconstruct the extensor mechanism of knee joint after resection of proximal tibial tumors

Abstract

Purpose The aim of this study was to evaluate the role of mesh technique in the reconstruction of the extensor mechanism after resection of proximal tibial tumors. Methods We retrospectively analyzed the cases of 14 patients who were diagnosed with proximal tibial tumors at our center and reconstructed with tumor prosthesis, gastrocnemius muscle, and mesh between 2012 and 2017. The treatment strategies for patellar tendon reconstruction primarily involve gastrocnemius reconstruction to cover the tumor prosthesis and mesh reconstruction for the patellar ligament. Results Among the 14 patients, the mean was 1.57° (range 0–12°) for active extension versus 105.00° (range 80–120°) for active flexion. The mean for passive extension was 0°. The passive flexion mean was 115.00° (range 90–120°). The extensor lag averaged 1.57° (range 0–12°), and the mean Musculoskeletal Tumor Society score (MSTS) was 23.57 (range 19–27). The average follow-up for all patients was 23.50 months (range 14–37). During the recent follow-up, all patients were able to walk without crutches. Two patients underwent above-the-knee amputation for local recurrence of the tumor, and lung metastasis occurred in three patients after operation. There were no postoperative complications. Conclusions Extensor lag was remarkably reduced in the surgery group in comparison to previous study reports. Surgical resection is a simple, reliable, and effective method to remove and control the tumor. Mesh reconstruction of patellar ligament is effective to reconstruct the extensor mechanism of the knee after excision of tumor.

Modular endoprosthetic replacement for proximal tibia tumor patients

“…Complications include non-oncological ones such as infections, allograft resorption, soft tissue failure, and so on. In our experience, in case of massive defects formed after tumor removal, the most effective method of surgery is modular endoprosthetic replacement, which allows to perform ablastic tumor removal and in the shortest possible time to activate patients for their limb function restoration [2,4,9,11,20].…”

“…The proximal tibia (PT) is one of the most common sites for primary malignant bone tumors [1,3]. In this segment of skeleton, we observed up to 15 % of all osteosarcomas, 11 % of Ewing's sarcomas and 6 % of chondrosarcomas [5,6,11,15,27]. By the end of 1970s, above-knee amputation was the standard treatment procedure for PT malignant tumors [7,10,[14][15][16].…”

“…Today, thanks to advances in radiological diagnostics, immunohistochemical studies, radical changes in general principles of treatment for primary malignant bone neoplasms, complex chemotherapy and improvement of surgeries it has changed. For example, technical modernization of endoprosthesis structures, organ-preserving surgery has become a standard method of treatment [1,2,5,6,8,9,11,15,16,27,28]. PT modular tumor endoprosthetic replacement is difficult to perform due to changeability of anatomical structure -there is a risk of injury of tibial nerve and popliteal vessels.…”

“…PT modular tumor endoprosthetic replacement is difficult to perform due to changeability of anatomical structure -there is a risk of injury of tibial nerve and popliteal vessels. Moreover, together with a complex surgical performance, there are problems with closing the defect with soft tissues [2][3][4][5][6][7]9,[11][12][13]15]. For these reasons, the reconstruction of PT after tumor removal is associated with a large number of complications compared to other parts of the skeleton -from 40 to 70 % according to different authors [3,4,7,8,10,13,14,16,21,22,24-28].…”

“…These include infections, structural disorders, aseptic instability, local recurrence, and a number of soft tissue lesions [3,8,11,[17][18][19][20][21][22][23][24][25][26]. To further standardize complications, E. R. Henderson et al [8] proposed a classification that was adopted in 2014 by the International Society of Limb Salvage (ISOLS).…”