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Chhajed BB, Mehta MA, Prajapati A. A Novel and Effective Surgical Technique for Reconstruction of Extensor Mechanism with Iliotibial Band Tendon Graft After Patellectomy for Primary Patella Tumor. Indian J Orthop 2024; 58:1310-1315. [PMID: 39170664 PMCID: PMC11333392 DOI: 10.1007/s43465-024-01190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/22/2024] [Indexed: 08/23/2024]
Abstract
Background Amongst primary patella tumor Campanacci grade 3 tumor of Giant cell tumor of bone (GCTB) and malignant tumors requires patellectomy. We had a patient with huge recurrent GCTB of patella with involvement of skin. We reconstructed extensor mechanism of Knee with long iliotibial band (ITB) tendon graft. Material and Methods After patellectomy, we harvested long ITB graft (length 22 cm; width proximally 6 cm, distally 1.5 cm) through patellectomy wound and small "L" shaped incision proximally. We passed ITB graft from patella tendon and quadriceps tendon in figure of 8 manner and sutured it back to itself and host tendon with fiber Wire and closed both the wounds primarily. We started ROM and quadriceps strengthening in graded manner. We measured functional outcome with Musculoskeletal Tumour Society (MSTS) scoring system. Results There were no post-operative complications. At 10 weeks follow up, patient had no extension lag and knee ROM was 90°. At final follow up of 7 months patient regained pre-operative functional status without knee instability. Her MSTS score was 30 and she was disease free. Conclusion Reconstruction of extensor mechanism of knee with ITB graft doesn't have donor site morbidity and gives excellent function with graded physiotherapy protocol.
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Affiliation(s)
| | - Milind A. Mehta
- Dr. Jivraj Mehta Smarak Health Foundation, Bakeri Medical Research Centre, Dr Jivraj Mehta Marg Paldi, Ahmedabad, Gujarat India
| | - Ashwin Prajapati
- Dr. Jivraj Mehta Smarak Health Foundation, Bakeri Medical Research Centre, Dr Jivraj Mehta Marg Paldi, Ahmedabad, Gujarat India
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Yokoyama N, Yanagawa T, Saito K, Chikuda H. A New Procedure for Reconstructing the Knee Extension Mechanism After Resection of the Knee Joint and Patella: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00050. [PMID: 36881662 DOI: 10.2106/jbjs.cc.22.00341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
CASE We reconstructed the knee extension mechanism using a novel procedure for a 16-year-old adolescent girl with osteosarcoma that invaded her femur, patella, and patellar tendon. The knee joint was replaced with a megaprosthesis, and the extension mechanism was reconstructed using artificial ligaments sandwiched with bone cement forming a patella. At the one-year follow-up, she could walk using a knee orthosis without crutches. CONCLUSIONS Reconstruction of the knee extension mechanism after patellectomy remains challenging. Our new method achieved an acceptable knee function and is, therefore, useful for patients undergoing excision of the knee joint and extension mechanism.
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Affiliation(s)
- Naoaki Yokoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Yanagawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Musculoskeletal Oncology, Gunma Prefectural Cancer Center, Maebashi, Japan
| | - Kenichi Saito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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DePalma BJ, Costales TG, Schneider MB, Henn RF. Bilateral Extensor Mechanism Allograft Reconstruction in Native Knees: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00031. [PMID: 35081064 DOI: 10.2106/jbjs.cc.21.00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 66-year-old man presented with chronic bilateral extensor mechanism dysfunction and profound patella baja after failed revision surgery for bilateral quadriceps tendon ruptures. Staged bilateral reconstruction with complete extensor mechanism allograft resulted in excellent two-year satisfaction and clinical outcomes. CONCLUSION Complete extensor mechanism reconstruction can be a successful treatment for chronic quadriceps tendon rupture with profound patella baja.
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Affiliation(s)
- Brian J DePalma
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Wide en bloc resection of an extraskeletal myxoid chondrosarcoma about the knee with single-stage knee extensor mechanism reconstruction: A case report. Knee 2021; 31:77-85. [PMID: 34118584 DOI: 10.1016/j.knee.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/11/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
Soft tissue sarcomas about the patellar tendon necessitate wide resection and thus present a significant reconstructive challenge. This article describes the novel use of a synthetic mesh graft to reconstruct the knee extensor mechanism as a single stage procedure after wide en bloc resection of an extraskeletal myxoid chondrosarcoma (EMC) in a patient with an invasive mass that was intimately associated with her patellar tendon.
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Wang J, Zhou Y, Wang YT, Min L, Zhang YQ, Lu MX, Tang F, Luo Y, Zhang YH, Zhang XL, Tu CQ. Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature. World J Clin Cases 2021; 9:2524-2532. [PMID: 33889617 PMCID: PMC8040175 DOI: 10.12998/wjcc.v9.i11.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/04/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Giant cell tumor (GCT) is a benign lesion and rarely involves the patella. This disease is characterized by a relatively high recurrence rate after primary treatment. En bloc resection has been a predominant option for recurrent GCT. However, total patellectomy can lead to disruption of the knee. Therefore, exploration of functional reconstruction of the extensor mechanism is worthwhile.
CASE SUMMARY A 54-year-old woman presented with right knee pain and swelling, and was diagnosed as having a GCT in the patella following curettage and autograft. Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture. Based on the combination of histological, radiological, and clinical features, a diagnosis of recurrent GCT in the patella was made (Campanacci grade III). After a multidisciplinary team discussion, three-dimensional (3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism. The patient was followed for 35 mo postoperatively. No evidence of local recurrence, pulmonary metastasis, or osteoarthritis of the right knee was observed. The active flexion arc was 0°-120°, and no extension lag was detected. A favorable patellar tracking and height (Insall-Salvati ratio 0.93) were detected by radiography.
CONCLUSION We depict a case of a GCT at the right patella, which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement. The patella normal reconstruction, the precise-fit articular design, and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Tian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Qi Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Min-Xun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ya-Han Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xian-Liang Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chong-Qi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Balestri W, Morris RH, Hunt JA, Reinwald Y. Current Advances on the Regeneration of Musculoskeletal Interfaces. TISSUE ENGINEERING PART B-REVIEWS 2021; 27:548-571. [PMID: 33176607 DOI: 10.1089/ten.teb.2020.0112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The regeneration of the musculoskeletal system has been widely investigated. There is now detailed knowledge about the organs composing this system. Research has also investigated the zones between individual tissues where physical, mechanical, and biochemical properties transition. However, the understanding of the regeneration of musculoskeletal interfaces is still lacking behind. Numerous disorders and injuries can degrade or damage tissue interfaces. Their inability to regenerate can delay the tissue repair and regeneration process, leading to graft instability, high morbidity, and pain. Moreover, the knowledge of the mechanism of tissue interface development is not complete. This review presents an overview of the most recent approaches of the regeneration of musculoskeletal interfaces, including the latest in vitro, preclinical, and clinical studies. Impact statement Interfaces between soft and hard tissues are ubiquitous within the body. These transition zones are crucial for joint motion, stabilisation and load transfer between tissues, but do not seem to regenerate well after injury or deterioration. The knowledge about their biology is vast, but little is known about their development. Various musculoskeletal disorders in combination with risk factors including aging and unhealthy lifestyle, can lead to local imbalances, misalignments, inflammation, pain and restricted mobility. Our manuscript reviews the current approaches taken to promote the regeneration of musculoskeletal interfaces through in vitro, pre-clinical and clinical studies.
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Affiliation(s)
- Wendy Balestri
- Department of Engineering and School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Robert H Morris
- Department of Physics and Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - John A Hunt
- Medical Technologies and Advanced Materials, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.,College of Biomedical Engineering, China Medical University, Taichung, Taiwan
| | - Yvonne Reinwald
- Department of Engineering and School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
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Campbell MP, Barnes BJ, Vap AR. Reconstruction of Chronic Patellar Tendon Injury with Achilles Tendon Allograft: A Case Report. JBJS Case Connect 2020; 10:e19.00619. [PMID: 32910605 DOI: 10.2106/jbjs.cc.19.00619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE There have been several methods described for the reconstruction of chronic patellar tendon injuries in the native knee. Here, we report a former athlete who sustained a tibial tubercle fracture as an adolescent and presented with functional deficits from a patellar tendon that healed in elongation after the removal of hardware and debridement of ossifications within the tendon. He underwent reconstruction with Achilles allograft. CONCLUSIONS Achilles tendon allograft is a good option for reconstructing chronic patellar tendon injuries. Our patient had an excellent outcome at 1 year.
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Affiliation(s)
- Michael P Campbell
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health Systems, Richmond, Virginia
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Gómez-Palomo JM, Jiménez-Garrido C, Martínez-Crespo A, García-Vera JJ, Pérez-Cardeña J, Montañez-Heredia E. Extensor Mechanism Allograft in Osteosarcoma of the Patella: A Case Report. JBJS Case Connect 2019; 9:e0277. [PMID: 31365362 DOI: 10.2106/jbjs.cc.18.00277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A 24-year-old female diagnosed with fibroblastic osteosarcoma of the patella underwent a total patellectomy and surgical reconstruction with a large bone-tendon allograft of the extensor mechanism and adjuvant chemotherapy. At 5 years' postoperative, the patient has adequate disease control and excellent joint function. CONCLUSIONS Reconstruction with an extensor mechanism allograft is an appropriate alternative for patients with malignant patella tumors without tumor contamination of the joint, allowing for satisfactory knee function and disease control.
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Affiliation(s)
- Juan M Gómez-Palomo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Carlos Jiménez-Garrido
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Ana Martínez-Crespo
- Department of Orthopedic Surgery and Traumatology, Hospital Público de Montilla, Córdoba, Spain
| | - Juan J García-Vera
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Javier Pérez-Cardeña
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Elvira Montañez-Heredia
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
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