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. 2024 Dec 16;16(24):4185.
doi: 10.3390/cancers16244185.

Joint-Sparing Resection of Juxta-Articular Primary Tumors of the Knee Using Titanium Alloy 3D-Printed Cutting Guides and Allograft Reconstruction

Maurizio Scorianz  1 , Guido Scoccianti  1 , Lorenzo Guariento  1 , Monica Carfagni  2 , Domenico Andrea Campanacci  1
Affiliations

Joint-Sparing Resection of Juxta-Articular Primary Tumors of the Knee Using Titanium Alloy 3D-Printed Cutting Guides and Allograft Reconstruction

Maurizio Scorianz et al. Cancers (Basel). .

Abstract

Background: Joint-sparing resection of juxta-articular knee tumors is challenging. With the development of 3D printing technology, custom-made cutting guides were introduced with the aim to improve the accuracy of tumor resection margins and to shape the allograft for adequate matching in biological reconstruction. Materials and Methods: Between December 2017 and July 2023, 13 patients underwent joint-sparing juxta-articular resection of the knee for a primary bone tumor at our institution. Resection was performed using a custom-made 3D-printed titanium alloy cutting guide and reconstruction was performed using a custom-shaped allograft. The mean follow up was 50 months (min 14-max 81). The study of cutting accuracy was performed by digital examination of CT images of the resection specimen in eight patients. Results: The average cutting error was 2.3 mm. Surgical margins were wide in all patients. Four patients developed postoperative complications that led to the removal of the allograft in one case. The average functional result according to the Musculoskeletal Tumor Society Score was 26 (min 14-max 30), and according to the Oxford Knee Score it was 44 (min 22-max 48). Conclusions: Custom-made titanium cutting guides resulted effective in improving the accuracy of joint-sparing juxta-articular resection of the knee and allograft matching.

Keywords: 3D printing; bone tumors; custom made; cutting guides; juxta-articular tumors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Treatment of a juxta-articular peripheral chondrosarcoma of the proximal tibia arising near the posterior cruciate ligament insertion (PCL). (a) Sagittal T1 weighted MRI showing the proximity of the tumor to the PCL insertion. (b) Axial T1 weighted MRI highlighting the origin of the tumor from the bony surface. (c) 3D model of the tumor (red) and of the PCL (green). (d,e) 3D model of the placement of the cutting guide around the tumor. (f) Application of the cutting guide to perform tumor resection, preserving the PCL insertion. (g,h) 3D model of the resection. (i,j) Specimen and CT scan of the specimen demonstrating wide margins. (k) Color map of the cutting errors of the specimen: the colors represent the difference between the preoperative surface of the digital planning and the surface of the resected bone. Green represents the ideal plane, while blue and red represent the osteotomy offset from the ideal plane. (l) Shaping of the allograft using an allograft-specific cutting guide to precisely fit the bone gap. (m) 3D model of the allograft reconstruction (blue). (n,o) Radiographs at one-year follow-up demonstrating integration of the allograft.
Figure 1
Figure 1
Treatment of a juxta-articular peripheral chondrosarcoma of the proximal tibia arising near the posterior cruciate ligament insertion (PCL). (a) Sagittal T1 weighted MRI showing the proximity of the tumor to the PCL insertion. (b) Axial T1 weighted MRI highlighting the origin of the tumor from the bony surface. (c) 3D model of the tumor (red) and of the PCL (green). (d,e) 3D model of the placement of the cutting guide around the tumor. (f) Application of the cutting guide to perform tumor resection, preserving the PCL insertion. (g,h) 3D model of the resection. (i,j) Specimen and CT scan of the specimen demonstrating wide margins. (k) Color map of the cutting errors of the specimen: the colors represent the difference between the preoperative surface of the digital planning and the surface of the resected bone. Green represents the ideal plane, while blue and red represent the osteotomy offset from the ideal plane. (l) Shaping of the allograft using an allograft-specific cutting guide to precisely fit the bone gap. (m) 3D model of the allograft reconstruction (blue). (n,o) Radiographs at one-year follow-up demonstrating integration of the allograft.
Figure 2
Figure 2
Treatment of a juxta-articular peripheral chondrosarcoma of the proximal tibia. (a) Axial T1 weighted MRI showing the tumor between the proximal tibia and fibula. (b) Tibial cortical erosion highlighted at the CT. (c) 3D model of the tumor (red) and of the cutting guide (blue). (d,e) Resection of the tumor. (f) 3D model of the resection. (g,h) Shaping of the allograft. (i) Allograft fixation. (j,k) CT scan of the specimen and color map of the cutting error. (l) CT scan showing allograft consolidation at 1-year follow-up.
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