Extensor Mechanism-Sparing Technique for Management of Proximal Tibia Sarcoma Resection: A Case Series Study

Abstract

The proximal tibia is one of the most challenging anatomic sites for resection of large bone tumors, due to the vicinity of the extensor mechanism. Here, we report outcomes of a novel radical resection technique which preserves the extensor apparatus. 8 patients were operated between 2001 and 2011 for large sarcomas with high-grade tibial localization. Six were giant cell tumor of bone histology (GCTB; defined as severe bone destruction and soft tissue extension) and two chrondrosarcoma at surgical grade G1, but with double localization in tibia and femur. Primary bone tumors and recurrences were treated with novel multiplanar resection technique avoiding removal of the tibial tuberosity and the patella tendon insertion, preserving extensor mechanism. In all cases, curettage and borage were not indicated due to extensive lesion size. Radical resection of the lower extremity (2 femurs and 8 tibias) yielded wide margins (R0) and patients were evaluated at 10 years of follow up. The average post operative Musculoskeletal Tumor Society (MSTS) score was 26.87 points (range: 23-29). All patients reached full passive and active extension and the maximum active flexion was 108.75° (range: 90°-120°). At the last follow-up (mean: 121.8 months), all patients and implants survived; no local infection, recurrence, metastasis, or relevant complications occurred. This surgical technique therefore appears to provide a safe treatment option when wide surgical margins are possible, and preserving the integrity of the extensor mechanism may improve the clinical outcome.