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Case Reports
. 2024;31(1):187-193.
doi: 10.15388/Amed.2024.31.1.24. Epub 2024 Feb 27.

Knee Extensor Apparatus Reconstruction with Allograft after Patellar Resection: A Case Report

Fabio Cosseddu  1 , Martina Cordoni  1 , Elena Bechini  1 , Edoardo Ipponi  1 , Francesco Rosario Campo  1 , Antonio D'Arienzo  1 , Lorenzo Andreani  1
Affiliations
Case Reports

Knee Extensor Apparatus Reconstruction with Allograft after Patellar Resection: A Case Report

Fabio Cosseddu et al. Acta Med Litu. 2024.

Abstract
in English, Italian

Background: The extensor apparatus of the knee can be thought of a chain that transmits the muscular strength developed by the quadriceps muscles to the proximal tibia. This complex is essential to allow the extension of the tibia over the femur, being essential to provide knee mobility and stability. In case of lesions which irreparably damage the patella, such as a locally aggressive bone tumor, it is necessary to restore both the apparatus' anatomical continuity and its strength.

Case report: A 39-years-old Caucasian man with a history of lung carcinoma developed atraumatic swelling and soreness in his left knee. Imaging evidence reported a degeneration of the left patella. We performed an en bloc resection of the patella and the nearby soft tissues of the extensor apparatus. The resulting gap was fulfilled with a massive allograft consisting of a quadriceps tendon, a patella and a patellar ligament. No complication or local recurrences were observed. At the patient's latest follow-up, he did not have any extension lag and quadriceps strength was completely restored.

Conclusion: Massive allografts can represent a reliable alternative for the reconstruction of the patella and the knee extensor apparatus in orthopedic oncology.

Įvadas: Kelio tiesiamąjį aparatą galima teigti esant grandine, kuri perduoda keturgalvio raumens raumenų sukurtą jėgą proksimaliniam blauzdikauliui. Šis kompleksas yra labai svarbus, kad blauzdikaulis galėtų išsitempti virš šlaunikaulio, ir yra būtinas kelio judrumui ir stabilumui užtikrinti. Esant pažeidimų, kurie negrįžtamai pažeidžia girnelę, pavyzdžiui, vietinio agresyvaus kaulų naviko atveju, būtina atkurti anatominį kelio tiesiamojo aparato vientisumą ir jo tvirtumą.

Atvejo aprašymas: 39 metų baltaodžiui, kuriam anksčiau buvo diagnozuota plaučių karcinoma, atsirado kairės kojos kelio atraminis patinimas ir skausmingumas. Vaizdiniais duomenimis nustatėme kairiojo kelio girnelės degeneraciją. Atlikome en bloc kelio girnelės ir šalia esančio tiesiamojo aparato minkštųjų audinių rezekciją. Atsiradusi spraga buvo užpildyta masyviu alografiniu transplantatu, kurį sudarė keturgalvio raumens sausgyslė, girnelė ir girnelės raištis. Komplikacijų ar vietinių recidyvų nebuvo. Paskutinio stebėjimo metu pacientas neturėjo jokio tiesimo sutrikimo, o keturgalvio raumens jėga buvo visiškai atkurta.

Išvada: Masyvūs alograftai gali būti patikima alternatyva kelio girnelės ir kelio girnelės tiesiamojo aparato rekonstrukcijai ortopedinėje onkologijoje.

Keywords: Allograft; Bone Metastasis; Extensor Apparatus; Patella; Rehabilitation.

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Figures

Figure 1
Figure 1
A CT scan that shows a degeneration of the left patella.
Figure 2
Figure 2
Surgical access with extensive exposition of the patella, which appears enlarged and deformed (A). The access was used to isolate the degenerated patella from the surrounding soft tissues (B).
Figure 3
Figure 3
Pictures showing the anterior knee after the resection (A), After one the allograft had been sutured in its distal end and tunneled within the native quadriceps tendon (B) and once it had been completely sutured to restore the continuity of the extensor apparatus (C).
See this image and copyright information in PMC

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