Extensor mechanism allograft and radiotherapy in the treatment of soft tissue sarcomas around the knee: Presentation of two clinical cases

Knee involvement of soft tissue sarcomas is rare and very difficult to treat. Reconstruction of the extensor mechanism of the knee is essential to restore the functionality. Functional outcome is compromised by poor soft tissue coverage, adjuvant local radiotherapy, and resection of the extensor app...

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Bibliographic Details
Published in:Revista española de cirugía ortopédica y traumatología 2015-11, Vol.59 (6), p.447-453
Main Authors: Illana-Mahiques, M, Baixauli-García, F, Angulo-Sánchez, M A, Amaya-Valero, J V, García-Forcada, I L
Format: Article
Language:Spanish
Subjects:
Adult
Aged
Humans
Knee - surgery
Male
Radiotherapy, Adjuvant
Reconstructive Surgical Procedures - methods
Sarcoma - radiotherapy
Sarcoma - surgery
Tendons - transplantation
Transplantation, Homologous
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Summary:Knee involvement of soft tissue sarcomas is rare and very difficult to treat. Reconstruction of the extensor mechanism of the knee is essential to restore the functionality. Functional outcome is compromised by poor soft tissue coverage, adjuvant local radiotherapy, and resection of the extensor apparatus. No results were found in the literature as regards treatment by resection and reconstruction of the extensor mechanism in combination with adjuvant radiotherapy. The effects of radiotherapy are also unknown in the allografts. . Two cases are presented of soft tissue sarcoma around de knee treated by resection, reconstruction of the extensor mechanism with cryopreserved cadaver allograft, and local radiotherapy. After more than 3 years of follow up, both patients are free of disease and have a good joint balance. Resection of the tumor with adequate safety margins and reconstruction using cadaveric allograft preserves the extensor mechanism and function of the limb. The soft tissue coverage is an added problem that can be solved by propeller fasciocutaneous flap coverage. After surgery, the limb must be immobilized with a knee brace locked in extension. Local radiotherapy contributes to local control of the disease. The reconstruction of the extensor mechanism of the knee with allograft is a functional alternative to amputation, and it does not contraindicate adjuvant radiotherapy to improve local control of the disease.
ISSN:1988-8856
DOI:10.1016/j.recot.2015.05.001