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


Müller, Daniel A; Beltrami, Giovanni; Scoccianti, Guido; Cuomo, Pierluigi; Totti, Francesca; Capanna, Rodolfo (2018). Allograft Reconstruction of the Extensor Mechanism after Resection of Soft Tissue Sarcoma. Advances in Orthopedics, 2018:6275861.

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.

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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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2018
Deposited On:18 Sep 2018 13:57
Last Modified:24 Sep 2019 23:36
Publisher:Hindawi Publishing Corporation
ISSN:2090-3464
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1155/2018/6275861
PubMed ID:29951320

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