RECONSTRUCTION OF THE KNEE STABILITY AFTER RESECTION OF TUMORS OF THE PROXIMAL FIBULA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Chunlin , ZHAO Shichang , ZHU Zhongsheng , SUN Jiao , DONG Yang , ZENG Bingfang.

Department of Orthopedics, the Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, 200233, P.R.China.;

Corresponding author：

Keywords：

Proximal fibular tumor; Knee stability; Function reconstruction

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Objective To investigate the method and the cl inical outcomes of reconstruction of the knee stability after resection of tumors of the proximal fibula. Methods The cl inical data were retrospectively analyzed, from 16 patients with tumors of the proximal fibula undergoing proximal fibular resections and reconstructions of the lateral collateral ligament and the tendon of the biceps femoris with anchors between January 2008 and December 2009 (test group). Five patients underwent proximal fibular resection but were not given reconstruction surgery at the same period as the control group. There was no significant difference in gender, ages, disease duration, and tumor site between 2 groups (P gt; 0.05). Lateral stress test was performed after operation; X-ray films were taken to measure the joint space. Musculoskeletal Tumor Society (MSTS) functional score system was used to evaluate the joint function. Results All incisions healed by first intention in 2 groups. Iatrogenic complete peroneal nerve function loss occurred in patients undergoing Malawer type II surgical resection. The patients in both groups were followed up 12 to 36 months, with an average of 30 months. One patient with osteosarcoma of the test group developed local recurrence, and died of lung and systemic metastases after 12 months; the other patients had no recurrence. At last follow-up, the results of knee lateral stress test were negative in the test group, and the joint space increased and was classified as grade A; the results of knee lateral stress test were positive in the control group, and the joint space was classified as grade D. The MSTS score was 97.5 ± 3.5 in the test group and 87.5 ± 3.5 in the control group, showing significant difference (t=2.85, P=0.01). Conclusion The reconstruction of the bony attachment of the lateral collateral ligament and the tendon of the biceps femoris with anchors after resection of the proximal fibula is a safe, rel iable, and simple technique to reconstruct knee stabil ity after resection of tumors of the proximal fibula.

Citation： ZHANG Chunlin,ZHAO Shichang,ZHU Zhongsheng,SUN Jiao,DONG Yang,ZENG Bingfang.. RECONSTRUCTION OF THE KNEE STABILITY AFTER RESECTION OF TUMORS OF THE PROXIMAL FIBULA. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(4): 441-444. doi: Copy

1.	Dahlin DC. Bone tumours: general aspects and data on 6221 Cases. 3rd ed. Springfield: Charles C Thomas Pub Ltd, 1978: 11-12.
2.	Unni KK. Dahlin bone tumors: Bone tumors general aspects and data on 11087 cases. Illinois: Lippincott-Raven, 1996: 172-264.
3.	赵世昌, 张春林. 腓骨近端肿瘤的手术治疗及对膝关节稳定性影响的研究进展. 中国骨肿瘤骨病, 2011, 10(2): 204-208.
4.	Capanna R, Scoccianti G, Campanacci DA, et al. Surgical technique: extraarticular knee resection with prosthesis-proximal tibia-extensor apparatus allograft for tumors invading the knee. Clin Orthop Relat Res, 2011, 469(10): 2905-2914.
5.	Saini R, Bali K, Gill SS, et al. En bloc resection of osteosarcoma of the proximal fibula. An analysis of 8 cases. Acta Orthop Belg, 2010, 76(6): 806-810.
6.	Mootha AK, Saini R, Dhillon M, et al. Modified resection technique for proximal fibular osteochondromas. Orthop Traumatol Surg Res, 2011, 97(5): 569-573.
7.	燕太强, 杨荣利, 郭卫. 腓骨近端成骨肉瘤的外科治疗. 中华外科杂志, 2008, 46(9): 661-663.
8.	Dieckmann R, Gebert C, Streitbürger A, et al. Proximal fibula resection in the treatment of bone tumours. Int Orthop, 2011, 35(11): 1689-1694.
9.	Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clin Orthop Relat Res, 1984, (186): 172-181.
10.	LaPrade RF, Heikes C, Bakker AJ, et al. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg (Am), 2008, 90(10): 2069-2076.
11.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedure after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
12.	Bickels J, Kollender Y, Pritsch T, et al. Knee stability after resection of the proximal fibula. Clin Orthop Relat Res, 2007, 454: 198-201.
13.	Coobs BR, LaPrade RF, Griffith CJ, et al. Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med, 2007, 35(9): 1521-1527.
14.	Abdel MP, Papagelopoulos PJ, Morrey ME, et al. Surgical management of 121 benign proximal fibula tumors. Clin Orthop Relat Res, 2010, 468(11): 3056-3062.
15.	Provencher MT, Ryu JH, Gaston T, et al. Technique: bone-patellar tendon-bone autograft ACL reconstruction in the young, active patient. J Knee Surg, 2011, 24(2): 83-92.
16.	Shino K, Mae T, Nakamura N. Surgical technique: revision ACL reconstruction with a rectangular tunnel technique. Clin Orthop Relat Res, 2012, 470(3): 843-852.
17.	Kang H, Wang F. The modified bone-patellar tendon-bone allograft in single-bundle anterior cruciate ligament reconstruction. Acta Orthop Belg, 2011, 77(3): 390-393.
18.	Daigeler A, Drücke D, Tatar K, et al. The pedicled gastrocnemius muscle flap: a review of 218 cases. Plast Reconstr Surg, 2009, 123(1): 250-257.

1. Dahlin DC. Bone tumours: general aspects and data on 6221 Cases. 3rd ed. Springfield: Charles C Thomas Pub Ltd, 1978: 11-12.
2. Unni KK. Dahlin bone tumors: Bone tumors general aspects and data on 11087 cases. Illinois: Lippincott-Raven, 1996: 172-264.
3. 赵世昌, 张春林. 腓骨近端肿瘤的手术治疗及对膝关节稳定性影响的研究进展. 中国骨肿瘤骨病, 2011, 10(2): 204-208.
4. Capanna R, Scoccianti G, Campanacci DA, et al. Surgical technique: extraarticular knee resection with prosthesis-proximal tibia-extensor apparatus allograft for tumors invading the knee. Clin Orthop Relat Res, 2011, 469(10): 2905-2914.
5. Saini R, Bali K, Gill SS, et al. En bloc resection of osteosarcoma of the proximal fibula. An analysis of 8 cases. Acta Orthop Belg, 2010, 76(6): 806-810.
6. Mootha AK, Saini R, Dhillon M, et al. Modified resection technique for proximal fibular osteochondromas. Orthop Traumatol Surg Res, 2011, 97(5): 569-573.
7. 燕太强, 杨荣利, 郭卫. 腓骨近端成骨肉瘤的外科治疗. 中华外科杂志, 2008, 46(9): 661-663.
8. Dieckmann R, Gebert C, Streitbürger A, et al. Proximal fibula resection in the treatment of bone tumours. Int Orthop, 2011, 35(11): 1689-1694.
9. Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clin Orthop Relat Res, 1984, (186): 172-181.
10. LaPrade RF, Heikes C, Bakker AJ, et al. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg (Am), 2008, 90(10): 2069-2076.
11. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedure after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
12. Bickels J, Kollender Y, Pritsch T, et al. Knee stability after resection of the proximal fibula. Clin Orthop Relat Res, 2007, 454: 198-201.
13. Coobs BR, LaPrade RF, Griffith CJ, et al. Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med, 2007, 35(9): 1521-1527.
14. Abdel MP, Papagelopoulos PJ, Morrey ME, et al. Surgical management of 121 benign proximal fibula tumors. Clin Orthop Relat Res, 2010, 468(11): 3056-3062.
15. Provencher MT, Ryu JH, Gaston T, et al. Technique: bone-patellar tendon-bone autograft ACL reconstruction in the young, active patient. J Knee Surg, 2011, 24(2): 83-92.
16. Shino K, Mae T, Nakamura N. Surgical technique: revision ACL reconstruction with a rectangular tunnel technique. Clin Orthop Relat Res, 2012, 470(3): 843-852.
17. Kang H, Wang F. The modified bone-patellar tendon-bone allograft in single-bundle anterior cruciate ligament reconstruction. Acta Orthop Belg, 2011, 77(3): 390-393.
18. Daigeler A, Drücke D, Tatar K, et al. The pedicled gastrocnemius muscle flap: a review of 218 cases. Plast Reconstr Surg, 2009, 123(1): 250-257.

Chinese Journal of Reparative and Reconstructive Surgery

RECONSTRUCTION OF THE KNEE STABILITY AFTER RESECTION OF TUMORS OF THE PROXIMAL FIBULA

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