Limb-sparing surgery for high-grade malignant tumors of the proximal tibia. Surgical technique and a method of extensor mechanism reconstruction.

A surgical technique designed for safe and easy access to the popliteal vessels, resection of a large segment of the tibia and knee joint, and a method of patellar/extensor mechanism reconstruction and soft-tissue coverage that utilizes a transferred medial gastrocnemius muscle is reported. Eleven patients have been treated with this technique, including seven patients with a minimum follow-up evaluation of two years (average, 49.5 months; range, 24.6-84.4 months). There were five males and two females, with an average age of 28.7 years. The histologic diagnoses were osteosarcoma, four patients; malignant fibrous histiocytoma, one patient; chondrosarcoma, one patient; and poorly differentiated sarcoma, one patient. The surgical stages were Stage IIA, one patient, and IIB, six patients. Six intraarticular resections and one extraarticular resection were performed; all were classified as wide excisions. Four prosthetic replacements and three arthrodeses were performed. Pathological specimens showed meniscal and patellar tendon involvement in two patients and pericapsular tibiofibular joint involvement in six patients. Local complications were transient peroneal nerve palsy in four patients and superficial skin slough in one patient. All resections obtained negative margins, and there was no local recurrence or metastatic disease. Functional results (Musculoskeletal Tumor Society System classification) were excellent in one patient, good in four, fair in one, and poor in one. Limb-sparing surgery for high-grade tumors of the proximal tibia is recommended for carefully selected patients.