Anatomical research and clinical application of extraarticular total knee resection
10.3760/cma.j.issn.0253-2352.2012.11.013
- VernacularTitle:关节外全膝关节切除术的解剖学观察和临床应用
- Author:
Qiang YANG
;
Jianmin LI
;
Zhiping YANG
;
Xin LI
;
Zhenfeng LI
;
Qunshan LU
;
Jun YAN
- Publication Type:Journal Article
- Keywords:
Knee joint;
Bone neoplasms;
Patella;
Patellar ligament
- From:
Chinese Journal of Orthopaedics
2012;32(11):1060-1065
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate technique of reservation and reconstruction of the extensor mechanism in extraarticular total knee resection.Methods There were 6 cases of fresh total knee joint specimen for anatomical observation.After meglumine diatrizoate was injected into the joint capsule and the deep infrapatellar bursa,the CT examination of the knee specimen was performed.The specimens were detached according to the requirement of extraarticular knee resection,after methylene blue was injected into the joints capsule.The relationships between articular capsule,infrapatellar fat pad and deep infrapatellar bursa were observed,as well as feasibility of extraarticular total knee resection.Four patients with malignant bone tumor around the knee were performed extraarticalar total knee resection.The patellar ligament was reserved completely in 2 patients whose infrapatellar fat pads were not be involved by tumor confirmed by deep infrapatellar bursa radiography.However,the patellar ligament was split along the coronal plane in 2patients who had not undergone deep infrapatellar bursa radiography.The patients were followed up to observe results of tumor control and function of the affected knees.Results Through anatomical observation,some bursas around the knee joints,such as the suprapatellar bursa and popliteal bursa,communicated with the joint cavity,while the deep infrapatellar bursa did not.Furthermore,the infrapatellar fat pad located between the patellar tendon and joint cavity to form a good barrier to tumor invasion.So the patellar tendon could be reserved completely if the infrapatellar fat pad was not involved.Four patients were followed up for 10 to 28 months (average,19 months).At final follow-up,there was no local recurrence and metastasis in all 4 patients.The range of flexion of the affected knees ranged from 95° to 118 ° (average,105 °),and the average extension lag was 22 ° (range,10° to 40 °).The MSTS score was 72.5％.Conclusion For patients with malignant bone tumor involving the knee,the deep infrapatellar bursa radiography should be performed routinely.The patellar ligament could be reserved completely in the extraarticular total knee resection when the deep infrapatellar bursa doesn't communicate with the joint cavity combined with presence of the infrapatellar fat pad.Sometimes,only reserving the superficial half of the patellar ligament also could meet the need of extension.The short-term result of tumor control and function of the affected knee are satisfactory.
