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. 2018 May 22:2018:6275861.
doi: 10.1155/2018/6275861. eCollection 2018.

Allograft Reconstruction of the Extensor Mechanism after Resection of Soft Tissue Sarcoma

Daniel A Müller  1 , Giovanni Beltrami  2 , Guido Scoccianti  2 , Pierluigi Cuomo  2 , Francesca Totti  2 , Rodolfo Capanna  3
Affiliations

Allograft Reconstruction of the Extensor Mechanism after Resection of Soft Tissue Sarcoma

Daniel A Müller et al. Adv Orthop. .

Abstract

Introduction: Soft tissue tumors around the knee joint still pose problems for the excision and subsequent reconstruction.

Methods: In the 6 included patients the soft tissue sarcoma has its base on the anterior surface of the extensor mechanism and expands towards the skin. The entire extensor apparatus (quadriceps tendon, patella, and patellar tendon) was resected and replaced by a fresh-frozen allograft.

Results: The mean follow-up was 6.7 years (range: 2-12.4 years). In two patients a local recurrence occurred, resulting in a 5-year local recurrence-free rate of 66.7% (95% CI: 19.5%-90.4%). Distant metastases were found in 4 patients resulting in a 5-year metastasis-free rate of 33.3% (95% CI: 4.6%-67.5%). Two patients underwent at least one revision surgery, including one patient in whom the allograft had to be removed. According to the ISOLS function score 24.7 points (range: 19-28 points) were achieved at the last follow-up. The mean active flexion of the knee joint was 82.5° (range: 25-120°) and a mean extension lag of 10° (range: 0-30°) was observed.

Conclusions: The replacement of the extensor mechanism by an allograft is a reasonable option, allowing wide margins and restoration of active extension in most patients.

Trial registration: The presented study is listed on the ISRCTN registry with trial number ISRCTN63060594.

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Figures

Figure 1
Figure 1
Inclusion criteria of the patients according to the tumor localization. Schematic illustration of a knee joint (lateral view). The patients were divided into 2 groups according the tumor localization. Patients with a superficially spreading lesion and no joint involvement were included in this study (indicated as number 1). If the tumor site is deep and involves the joint space (indicated as number 2) an extra-articular resection of the knee was performed.
Figure 2
Figure 2
Surgical technique. Clinical case (patient number 4) as example for the surgical technique used in the described study population. (a) Complete resection of lesion and extensor apparatus; (b) preparation of the osteotendinous allograft; (c) fixation of the allograft with screws distally and direct end-to-end suture proximally; (d) postoperative radiography.
Figure 3
Figure 3
Local recurrence-free survival curve. Kaplan-Meier curve for local recurrence-free survival.
See this image and copyright information in PMC

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