Skip to main content
SpringerLink
Log in

Successful mid- to long-term outcome after reconstruction of the extensor apparatus using proximal tibia-patellar tendon composite allograft

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the study was to assess the outcomes of extensor mechanism reconstruction with proximal tibia-patellar tendon composite allograft.

Methods

24 consecutive patients treated with allograft-prosthetic composite for proximal tibia tumour resection and a conventional total knee arthroplasty were included. Extensor mechanism reconstruction was performed with a proximal tibia-patellar tendon composite allograft and the suture of the donor tendon to the remnant native patellar tendon. Function was evaluated by the Musculoskeletal Tumor Society score (MSTS) and range of motion. Western Ontario and MacMaster University (WOMAC) and visual analogue scale for pain also were used.

Results

After a mean follow-up of 11.7 (range 3–15) years, mean MSTS score was 22.4 (range 20–30), mean flexion was 94.0° (range 84°–110°), and mean extension lag was 7.2° (range 0°–18°). The mean VAS-pain was 4.3 (range 2–6), and WOMAC score was 72.4 (range 58–100). There was no failure of the reconstructed extensor mechanism.

Conclusion

Patellar tendon reconstruction with allogeneic tissue from the proximal tibia allograft sutured to the recipient’s remnant patellar tendon provides the mechanical support needed for healing of the reconstructed extensor mechanism with a substantial functional benefit to stabilize active knee extension and successful reconstruction survival at long-term.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Albergo JI, Gaston CL, Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL, Jeys LM, Carter SR, Tillman RM, Abudu AT, Grimer RJ (2017) Proximal tibia reconstruction after bone tumor resection: are survivorship and outcomes of endoprosthetic replacement and osteoarticular allograft similar? Clin Orthop Relat Res 475:676–682

    Article  Google Scholar 

  2. Anract P, Missenard G, Jeanrot C, Dubois V, Tomeno B (2001) Knee reconstruction with prosthesis and muscle flap after total arthrectomy. Clin Orthop Relat Res 384:208–216

    Article  Google Scholar 

  3. Ayerza MA, Aponte-Tinao LA, Abalo E, Muscolo DL (2006) Continuity and function of patellar tendon host-donor suture in tibial allograft. Clin Orthop Relat Res 450:33–38

    Article  Google Scholar 

  4. Barrack RL, Lyons T (2000) Proximal tibia-extensor mechanism composite allograft for revision TKA with chronic patellar tendon rupture. Acta Orthop Scand 71:419–421

    Article  CAS  Google Scholar 

  5. Bellamy N, Buchanan W, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip and the knee. J Rheumatol 15:1833–1840

    CAS  Google Scholar 

  6. Biau DJ, Dumaine V, Babinet A, Tomeno B, Anract P (2007) Allograft-prosthesis composites after bone tumor resection at the proximal tibia. Clin Orthop Relat Res 456:211–217

    Article  Google Scholar 

  7. Bickels J, Wittig JC, Kollender Y, Neff RS, Kellar-Graney K, Meller I, Malawer MM (2001) Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement. J Arthroplasty 16:856–862

    Article  CAS  Google Scholar 

  8. Burnett RS, Butler RA, Barrack RL (2006) Extensor mechanism allograft reconstruction in TKA at a mean of 56 months. Clin Orthop Relat Res 452:159–165

    Article  CAS  Google Scholar 

  9. Capanna R, Scoccianti G, Campanacci DA, Beltrami G, De Biase P (2011) Extraarticular knee resection with prosthesis–proximal tibia-extensor apparatus allograft for tumors invading the knee. Clin Orthop Relat Res 469:2905–2914

    Article  Google Scholar 

  10. Diaz-Ledezma C, Orozco FR, Delasotta LA, Lichstein PM, Post ZD, Ong AC (2014) Extensor mechanism reconstruction with Achilles tendon allograft in TKA: results of an abbreviate rehabilitation protocol. J Arthroplasty 29:1211–1215

    Article  Google Scholar 

  11. Donati D, Colangeli M, Colangeli S, Di Bella C, Mercuri M (2008) Allograft-prosthetic composite in the proximal tibia after bone tumor resection. Clin Orthop Relat Res 466:459–465

    Article  Google Scholar 

  12. Ek EW, Rozen WM, Ek ET, Rudiger HA (2011) Surgical options for reconstruction of the extensor mechanism of the knee after limb-sparing sarcoma surgery: an evidence-based review. Arch Orthop Trauma Surg 131:487–495

    Article  Google Scholar 

  13. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246

    Google Scholar 

  14. Farfalli GL, Aponte-Tinao LA, Ayerza MA, Muscolo DL, Boland PJ, Morris CD, Athanasian EA, Healey JH (2013) Comparison between constrained and semiconstrained knee allograft-prosthesis composite reconstructions. Sarcoma. https://doi.org/10.1155/2013/489652

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gilbert NF, Yasko AW, Oates SD, Lewis VO, Cannon CP, Lin PP (2009) Allograft-prosthetic composite reconstruction of the proximal part of the tibia: an analysis of the early results. J Bone Joint Surg Am 91:1646–1656

    Article  Google Scholar 

  16. Glasser D, Langlais F (1991) The ISOLS radiological implants evaluation system. In: Langlais F, Tomeno B (eds) Limb salvage: major reconstructions in oncologic and nontumoral conditions. Springer, Berlin, pp 1–9

    Google Scholar 

  17. Höll S, Schlomberg A, Gosheger G, Dieckmann R, Streitbuerger A, Schulz D, Hardes J (2012) Distal femur and proximal tibia replacement with megaprosthesis in revision knee arthroplasty: a limb-saving procedure. Knee Surg Sports Traumatol Arthrosc 20:2513–2518

    Article  Google Scholar 

  18. Jaureguito JW, Dubois CM, Smith SR, Gottlieb LJ, Finn HA (1997) Medial gastrocnemius flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am 79-A:866–873

    Article  Google Scholar 

  19. Jentzsch T, Erschbamer M, Seeli F, Fuchs B (2013) Extensor function after medial gastrocnemius flap reconstruction of the proximal tibia. Clin Orthop Relat Res 471:2333–2339

    Article  Google Scholar 

  20. Lamberti A, Balato G, Summa PP, Rajgopal A, Vasdev A, Baldini A (2018) Surgical options for chronic patellar tendon rupture in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:1429–1435

    Article  Google Scholar 

  21. Liu B, Tan JC, Wang HL, Wu Z, Yuan ZC, Wei CY (2019) The role of mesh technology with tumor prosthesis reconstruction to reconstruct the extensor mechanism of knee joint after resection of proximal tibial tumors. J Orthop Surg Res 14:64–69

    Article  CAS  Google Scholar 

  22. Llombart Blanco R, Valentí A, Díaz de Rada P, Mora G, Valentí JR (2014) Reconstruction of the extensor mechanism with fresh-frozen tendon allograft in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:2771–2775

    Article  Google Scholar 

  23. Malawer MM, Price WM (1984) Gastrocnemius transposition flap in conjunction with limb-sparing surgery for primary bone sarcomas around the knee. Plast Reconstr Surg 73:741–750

    Article  CAS  Google Scholar 

  24. Mavrogenis AF, Pala E, Angelini A, Ferraro A, Ruggieri P (2012) Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol 107:335–342

    Article  Google Scholar 

  25. Müller DA, Beltrami G, Scoccianti G, Cuomo P, Capanna R (2016) Allograft-prosthetic composite versus megaprosthesis in the proximal tibia: what works best? Injury 47(suppl 4):124–130

    Article  Google Scholar 

  26. Muscolo DL, Ayerza MA, Farfalli G, Aponte-Tinao LA (2010) Proximal tibia osteoarticular allografts in tumor limb salvage surgery. Clin Orthop Relat Res 468:1396–1404

    Article  Google Scholar 

  27. Puerta-GarciaSandoval P, Lizaur-Utrilla A, Trigueros-Rentero MA, Lopez-Prats FA (2019) Mid- to long-term results of allograft-prosthesis composite reconstruction after removal of a distal femoral malignant tumor are comparable to those of the proximal tibia. Knee Surg Sports Traumatol Arthrosc 27:2218–2225

    Article  Google Scholar 

  28. Ricciardi BF, Oi K, Trivellas M, Lee YY, Della Valle AG, Westrich GH (2017) Survivorship of extensor mechanism allograft reconstruction after total knee arthroplasty. J Arthroplasty 32:183–188

    Article  Google Scholar 

Download references

Funding

No fundings have been or will be received by any author.

Author information

Authors and Affiliations

  1. Unit of Bone Tumors, Department of Orthopaedic Surgery, Arrixaca University Hospital, Murcia, Spain

    Pablo Puerta-GarciaSandoval & Maria A. Trigueros-Rentero

  2. Department of Traumatology and Orthopaedics, Miguel Hernandez University, Alicante, Spain

    Alejandro Lizaur-Utrilla, Adolfo Perez-Aznar, Carolina Alonso-Montero & Fernando A. Lopez-Prats

  3. Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain

    Alejandro Lizaur-Utrilla

Authors
  1. Pablo Puerta-GarciaSandoval
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alejandro Lizaur-Utrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria A. Trigueros-Rentero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adolfo Perez-Aznar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carolina Alonso-Montero
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fernando A. Lopez-Prats
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alejandro Lizaur-Utrilla.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The study was approved by our institutional IRB, Elda University Hospital, project number PI2019-034.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Puerta-GarciaSandoval, P., Lizaur-Utrilla, A., Trigueros-Rentero, M.A. et al. Successful mid- to long-term outcome after reconstruction of the extensor apparatus using proximal tibia-patellar tendon composite allograft. Knee Surg Sports Traumatol Arthrosc 29, 982–987 (2021). https://doi.org/10.1007/s00167-020-06062-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06062-w

Keywords

Search

Navigation