Document Detail


Extensor function after medial gastrocnemius flap reconstruction of the proximal tibia.
MedLine Citation:
PMID:  23423620     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several methods are available. A medial gastrocnemius flap commonly is used, although it may be associated with an extensor lag. This problem also is encountered, although perhaps to a lesser extent, with other techniques for reconstruction of the extensor apparatus. It is not known how such lag develops with time and how it correlates with functional outcome.
QUESTIONS/PURPOSES: We therefore (1) assessed patellar height with time, (2) correlated patellar height with function using the Musculoskeletal Tumor Society (MSTS) score, and (3) correlated patellar height with range of motion (ROM) after medial gastrocnemius flap reconstruction.
METHODS: Sixteen patients underwent tumor endoprosthesis implantation and extensor apparatus reconstruction between 1997 and 2009 using a medial gastrocnemius flap after sarcoma resection of the proximal tibia. These patients represented 100% of the population for whom we performed extensor mechanism reconstructions during that time. The minimum followup was 2 years (mean, 5 years; range, 2-11 years). Fourteen patients were alive at the time of this study. We used the Blackburne-Peel Index to follow patellar height radiographically with time. Functional outcomes were assessed retrospectively using the MSTS, and ROM was evaluated through active extensor lag and flexion.
RESULTS: Eleven patients had patella alta develop, whereby the maximal patellar height was reached after a mean of 2 years and then stabilized. More normal patellar height was associated with better functional scores, a smaller extensor lag, but less flexion; the mean extensor lag (and flexion) of patients with patella alta was 17° (and 94°) compared with only 4° (and 77°) without.
CONCLUSIONS: In our patients patella alta evolved during the first 2 postoperative years. Patella alta is associated with extensor lag, greater flexion, and worse MSTS scores. Surgical fixation of the patellar tendon more distally to its anatomic position or strict postoperative bracing may be advisable.
LEVEL OF EVIDENCE: Level IV, clinical cohort study. See the Guidelines for Authors for a complete description of levels of evidence.
Authors:
Thorsten Jentzsch; Matthias Erschbamer; Franziska Seeli; Bruno Fuchs
Publication Detail:
Type:  Journal Article     Date:  2013-02-20
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-10     Completed Date:  2013-08-28     Revised Date:  2014-07-01    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2333-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Arthroplasty, Replacement, Knee* / adverse effects
Biomechanical Phenomena
Bone Neoplasms / physiopathology,  radiography,  surgery*
Humans
Knee Joint / physiopathology,  radiography,  surgery*
Muscle, Skeletal / surgery*
Osteosarcoma / physiopathology,  radiography,  surgery*
Osteotomy* / adverse effects
Patella / physiopathology,  radiography
Postoperative Complications / etiology
Range of Motion, Articular
Reconstructive Surgical Procedures* / adverse effects
Recovery of Function
Retrospective Studies
Surgical Flaps* / adverse effects
Tibia / physiopathology,  radiography,  surgery*
Time Factors
Treatment Outcome
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