Skip to main content
Erschienen in: Clinical Orthopaedics and Related Research® 7/2008

01.07.2008 | Surgical Technique

Protecting a Patellar Ligament Reconstruction after Proximal Tibial Resection: A Simplified Approach

verfasst von: Vijay Titus, MS (Orth), Dip Orth, Mark Clayer, MD, MBBS, FRACS, FAOrthA

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 7/2008

Einloggen, um Zugang zu erhalten

Abstract

Limb salvage in tumor surgery has encouraged the development of megaprostheses. However, reattaching the ligamentum patellae poses a particular problem: avulsion and/or extensor lag may lead to poor function. We describe a new technique of patellar ligament reconstruction. The technique involves reattachment of the patellar ligament to the tibial tuberosity of the proximal tibial megaprosthesis, which has a porous surface created, and the repair is protected with a cerclage wire through the patella and the prosthesis. In 10 consecutive patients, the range of motion averaged 95° (median, 90°; range, 70°–120°), and the mean extension lag averaged 4° (median, 0°; range, 0°–20°). We had one case of patellar ligament avulsion. This technique resulted in good quadriceps function and a low incidence of complications.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Literatur
1.
Zurück zum Zitat Abboud J, Patel R, Donthineni-Rao R, Lackman R. Proximal tibial segmental prosthetic replacement without the use of muscle flaps. Clin Orthop Relat Res. 2003;414:189–196.PubMedCrossRef Abboud J, Patel R, Donthineni-Rao R, Lackman R. Proximal tibial segmental prosthetic replacement without the use of muscle flaps. Clin Orthop Relat Res. 2003;414:189–196.PubMedCrossRef
2.
Zurück zum Zitat Ayerza M, Aponte-Tinao L, Abalo E, Muscolo D. Continuity and function of patellar tendon host-donor suture in tibial allograft. Clin Orthop Relat Res. 2006;450:33–38.PubMedCrossRef Ayerza M, Aponte-Tinao L, Abalo E, Muscolo D. Continuity and function of patellar tendon host-donor suture in tibial allograft. Clin Orthop Relat Res. 2006;450:33–38.PubMedCrossRef
3.
Zurück zum Zitat Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement after bone tumor resection. J Bone Joint Surg Am. 2006;88:1285–1293.PubMedCrossRef Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement after bone tumor resection. J Bone Joint Surg Am. 2006;88:1285–1293.PubMedCrossRef
4.
Zurück zum Zitat Biau DJ, Dumaine V, Babinet A, Tomeno B, Anract P. Allograft-prosthesis composites after bone tumor resection at the proximal tibia. Clin Orthop Relat Res. 2007;456:211–217.PubMedCrossRef Biau DJ, Dumaine V, Babinet A, Tomeno B, Anract P. Allograft-prosthesis composites after bone tumor resection at the proximal tibia. Clin Orthop Relat Res. 2007;456:211–217.PubMedCrossRef
5.
Zurück zum Zitat Bickels J, Wittig JC, Kollender Y, Neff RS, Kellar-Graney K, Meller I, Malawer MM. Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement. J Arthroplasty. 2001;16:856–862.PubMedCrossRef Bickels J, Wittig JC, Kollender Y, Neff RS, Kellar-Graney K, Meller I, Malawer MM. Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement. J Arthroplasty. 2001;16:856–862.PubMedCrossRef
6.
Zurück zum Zitat Burnett RS, Berger RA, Paprosky WG, Della Valle CJ, Jacobs JJ, Rosenberg AG. Extensor mechanism allograft reconstruction after total knee arthroplasty: a comparison of two techniques. J Bone Joint Surg Am. 2004;86:2694–2699.PubMedCrossRef Burnett RS, Berger RA, Paprosky WG, Della Valle CJ, Jacobs JJ, Rosenberg AG. Extensor mechanism allograft reconstruction after total knee arthroplasty: a comparison of two techniques. J Bone Joint Surg Am. 2004;86:2694–2699.PubMedCrossRef
7.
Zurück zum Zitat Crossett LS, Sinha RK, Sechriest VF, Rubash HE. Reconstruction of a ruptured patellar tendon with Achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am. 2002;84:1354–1361.PubMed Crossett LS, Sinha RK, Sechriest VF, Rubash HE. Reconstruction of a ruptured patellar tendon with Achilles tendon allograft following total knee arthroplasty. J Bone Joint Surg Am. 2002;84:1354–1361.PubMed
8.
Zurück zum Zitat Davis AM, O’Sullivan R, Bell RS, Turcotte R, Catton CN, Wunder JS, Chabot P, Hammond A, Benk V, Isler M, Freeman C, Goddard K, Bezjak A, Kandel RA, Sadura A, Day A, James K, Tu D, Pater J, Zee B. Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2002;20:4472–4477.PubMedCrossRef Davis AM, O’Sullivan R, Bell RS, Turcotte R, Catton CN, Wunder JS, Chabot P, Hammond A, Benk V, Isler M, Freeman C, Goddard K, Bezjak A, Kandel RA, Sadura A, Day A, James K, Tu D, Pater J, Zee B. Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2002;20:4472–4477.PubMedCrossRef
9.
Zurück zum Zitat Dominkus M, Sabeti M, Toma C, Abdolvahab F, Trieb K, Kotz RI. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res. 2006;453:328–334.PubMedCrossRef Dominkus M, Sabeti M, Toma C, Abdolvahab F, Trieb K, Kotz RI. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res. 2006;453:328–334.PubMedCrossRef
10.
Zurück zum Zitat Eckardt JJ, Matthews JG 2nd, Eilber FR. Endoprosthetic reconstruction after bone tumor resections of the proximal tibia. Orthop Clin North Am. 1991;22:149–160.PubMed Eckardt JJ, Matthews JG 2nd, Eilber FR. Endoprosthetic reconstruction after bone tumor resections of the proximal tibia. Orthop Clin North Am. 1991;22:149–160.PubMed
11.
Zurück zum Zitat Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res. 1986;204:9–24.PubMed Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res. 1986;204:9–24.PubMed
12.
Zurück zum Zitat Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res. 2001;393:264–271.PubMedCrossRef Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res. 2001;393:264–271.PubMedCrossRef
13.
Zurück zum Zitat Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br. 2000;81:488–494.CrossRef Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br. 2000;81:488–494.CrossRef
14.
Zurück zum Zitat Jarvela T, Halonen P, Jarvela K, Moilanen T. Reconstruction of ruptured patellar tendon after total knee arthroplasty: a case report and a description of an alternative fixation method. Knee. 2005;12:139–143.PubMedCrossRef Jarvela T, Halonen P, Jarvela K, Moilanen T. Reconstruction of ruptured patellar tendon after total knee arthroplasty: a case report and a description of an alternative fixation method. Knee. 2005;12:139–143.PubMedCrossRef
15.
Zurück zum Zitat Jaureguito JW, Dubois CM, Smith SR, Gottlieb LJ, Finn HA. Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am. 1997;79:866–873.PubMedCrossRef Jaureguito JW, Dubois CM, Smith SR, Gottlieb LJ, Finn HA. Medial gastrocnemius transposition flap for the treatment of disruption of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am. 1997;79:866–873.PubMedCrossRef
16.
Zurück zum Zitat Kendall SJ, Singer GC, Briggs TW, Cannon SR. A functional analysis of massive knee replacement after extra-articular resections of primary bone tumors. J Arthroplasty. 2000;15:754–760.PubMedCrossRef Kendall SJ, Singer GC, Briggs TW, Cannon SR. A functional analysis of massive knee replacement after extra-articular resections of primary bone tumors. J Arthroplasty. 2000;15:754–760.PubMedCrossRef
17.
Zurück zum Zitat Kollender Y, Bender B, Weinbroum AA, Nirkin A, Meller I, Bickels J. Secondary reconstruction of the extensor mechanism using part of the quadriceps tendon, patellar retinaculum, and Gore-Tex strips after proximal tibial resection. J Arthroplasty. 2004:19;354–360.PubMedCrossRef Kollender Y, Bender B, Weinbroum AA, Nirkin A, Meller I, Bickels J. Secondary reconstruction of the extensor mechanism using part of the quadriceps tendon, patellar retinaculum, and Gore-Tex strips after proximal tibial resection. J Arthroplasty. 2004:19;354–360.PubMedCrossRef
18.
Zurück zum Zitat Shimose S, Sugita T, Kubo T, Matsuo T, Ochi M. Reconstructed patellar tendon length after proximal tibia prosthetic replacement. Clin Orthop Relat Res. 2005;439:176–180.PubMedCrossRef Shimose S, Sugita T, Kubo T, Matsuo T, Ochi M. Reconstructed patellar tendon length after proximal tibia prosthetic replacement. Clin Orthop Relat Res. 2005;439:176–180.PubMedCrossRef
19.
Zurück zum Zitat Wunder JS, Leitch K, Griffin AM, Davis AM, Bell RS. Comparison of two methods of reconstruction for primary malignant tumors at the knee: a sequential cohort study. J Surg Oncol. 2001;77:89–99, discussion 100. Wunder JS, Leitch K, Griffin AM, Davis AM, Bell RS. Comparison of two methods of reconstruction for primary malignant tumors at the knee: a sequential cohort study. J Surg Oncol. 2001;77:89–99, discussion 100.
Metadaten
Titel
Protecting a Patellar Ligament Reconstruction after Proximal Tibial Resection: A Simplified Approach
verfasst von
Vijay Titus, MS (Orth), Dip Orth
Mark Clayer, MD, MBBS, FRACS, FAOrthA
Publikationsdatum
01.07.2008
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 7/2008
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-008-0239-y

Weitere Artikel der Ausgabe 7/2008

Clinical Orthopaedics and Related Research® 7/2008 Zur Ausgabe

Symposium: Molecular and Clinical Developments in Tendinopathy

Successful Management of Tendinopathy With Injections of the MMP-inhibitor Aprotinin

Symposium: Molecular and Clinical Developments in Tendinopathy

The Classic: Inflammation of the Post-calcaneal Bursa Associated with Exostosis

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.