Abstract
IntroductionReconstruction after wide resection for a sarcoma involving the knee extensor mechanism is challenging even if the tumor is small.Case descriptionWe report on four consecutive peri-patellar tendon sarcomas treated similarly at a single institution. Histological diagnoses were synovial sarcoma (two cases), clear cell sarcoma and extraskeletal Ewing’s sarcoma (one case each). Follow-up periods after surgery were 18–67 months. All cases underwent pre-operative radiotherapy and subsequent surgery. After preoperative radiotherapy and wide resection including the patellar tendon, bone-patellar tendon-bone allograft was fixed to the residual patella and tibial tuberosity with screws and a cable wire. Soft tissue and skin defect over allograft was covered by free antero-lateral thigh flap. Post-operatively, the operated knee was splinted straight for at least 6 weeks, and then range-of-motion exercise was gradually introduced. Except for one case with a proximal tibial stress fracture 5 months post-operatively, no complication was observed. Both bone–bone junctions between allograft and residual bones were united within 1 year after surgery. At the latest clinical follow-up, all the patients had satisfactory functions with Musculoskeletal Tumor Society score of 28–30 out of 30 points and virtually full range of motion.Discussion and evaluationThis case series is the first to report bone-patellar tendon-bone allograft for reconstruction after tumor resection with joint preservation and with satisfactory clinical outcomes.ConclusionsBone-patellar tendon-bone allograft reconstruction with vascularized flap reconstruction is a viable option for peri-patella tendon sarcomas.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1510-9) contains supplementary material, which is available to authorized users.
Highlights
BackgroundThe mainstay of soft tissue sarcoma treatment for cure is surgical resection with or without adjuvant therapy, but functional loss after wide resection sometimes can be crucial
Reconstruction after wide resection for a sarcoma involving the knee extensor mechanism is challenging even if the tumor is small.Case description: We report on four consecutive peri-patellar tendon sarcomas treated at a single institution
Bone-patellar tendon-bone allograft reconstruction with vascularized flap reconstruction is a viable option for peri-patella tendon sarcomas
Summary
The mainstay of soft tissue sarcoma treatment for cure is surgical resection with or without adjuvant therapy, but functional loss after wide resection sometimes can be crucial. The aim of this study is to highlight a novel reconstruction option using bone-patellar tendon-bone (BPTB) allograft for peri-patellar tendon sarcomas, including post-operative management, and to reveal its advantages and disadvantages compared to previous reports. Post-operative management was similar to Patient 1, with the reduced period of the knee brace maintained in straight of 8 weeks, reflecting on the slightly limited ROM in the previous case. At 48 months post-operatively, the patient was continuously free of disease and his knee function was satisfactory, with minor knee extension lag (
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