Reconstruction of the Extensor Apparatus After Total Patellectomy in Orthopedic Oncology: A Systematic Literature Review

TL;DR

This study reviews surgical techniques for reconstructing the knee after removing the entire patella, focusing on functional outcomes and complications.

Contribution

The paper provides a systematic review of surgical approaches and outcomes after total patellectomy, offering guidance for orthopedic oncology.

Findings

Direct suture of the extensor apparatus is suitable for small tissue defects.

Larger gaps require muscle flaps, transfers, or soft tissue augments for reconstruction.

Allografts are recommended for extensive involvement of the patellar ligament or quadriceps tendon.

Abstract

Background: Patellar resection is recommended in cases of massive cortical bone disruption or malignancies. Modern literature lacks a consensus surgical reconstruction after total patellectomy. Our study reviews the surgical techniques described in the literature and summarizes the reported functional outcomes and complication rates. Materials: We systematically reviewed the existing literature, searching the PubMed, Embase, and Scopus databases for articles published between 1950 and 2024. We recorded age, diagnosis, tumor size, Lodwick classification, soft tissue involvement, and pre-operative fractures for each case or case series. We also recorded the reconstructive approaches. Complications, local recurrences, MSTS scores, and knee range of motion (ROM) were considered when reported. Results: Twenty-eight articles met our inclusion criteria. Among these, 4 were case series and 24 were case reports. A total of 47 cases treated with total patellectomy were reviewed. Reconstruction was performed with direct suture in 8 cases, while 17 had local augments, including allograft (10 cases), muscle flaps or transportations (4), autologous bone (1), or a composite (2). Reconstruction was not mentioned in 22 cases. ROM was reported for 17 cases, and the MSTS score was reported for 9 cases. Conclusions: In cases of relatively small tissue defects, a direct suture of the extensor apparatus can allow adequate functional recovery. In cases of larger gaps, surgeons should use muscle flaps, transfers, or soft tissue augments. Massive bone and tendon allografts should mainly be considered in cases where the neoplasm was not confined to the patella but extensively involved the patellar ligament or the quadriceps tendon.

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