Experimental study of the patellar tendon fixation strength after its reconstruction
Modular replacement is an adequate method of treatment after removal of proximal tibia tumors. However, there are problems with the restoration of the knee joint function, its extensor mechanism. Objective: to determine the strength of patellar ligament fixation under modeling on the knee joint of a pig. The reconstruction of the extensor mechanism was made with a nylon tape or attachment tube to fix the patellar ligament to the proximal tibia tuberosity. Methods: on the preparations of the pigs knee joints, the reconstruction of the extensor mechanism was simulated in two series of the experiment: I — grafting of the patellar ligament using a nylon tape; II — grafting with attachment tube, previously fixed to the proximal part of the tibia. The samples were tested for strength under the influence of a tension loading, the value of which was gradually increased until the patellar ligament was torn off from the tibia. The obtained results were processed statistically. Results: samples of the I series withstood the load before failure on average 1.4 times less than in the II series (t = –4.820; p = 0.001). The average values of the load that caused the tearing of the patellar ligament were significantly different, however, the maximum value of the series of breaking load of series I did not intersect with the minimum value of the series of data of series II. Detachment of the ligament from the patella occurred due to the eruption, and not the destruction of the suture material. Conclusions: the attachment tube is 1.4 times stronger (p < 0.01) than nylon tape. Due to this, the knee joint movements, and operated limb weight bearing can be started in the early postoperative period, thereby reducing the number of complications and improving the functional outcomes of surgeries in patients with proximal tibia tumors.
Full Text:PDF (Українська)
Elomaa, I., Blomqvist, C., Saeter, G., Åkerman, M., Stenwig, E., Wiebe, T., & Alvegård, T. (2000). Five-year results in Ewing's sarcoma. The Scandinavian Sarcoma Group experience with the SSG IX protocol. European Journal of Cancer, 36 (7), 875–880. doi: 10.1016/s0959-8049(00)00028-9
Bickels, J., Wittig, J. C., Kollender, Y., Neff, R. S., Kellar-Graney, K., Meller, I., & Malawer, M. M. (2001). Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement. The Journal of Arthroplasty, 16 (7), 856–862. doi: 10.1054/arth.2001.25502
Holzapfel, B. M., Pilge, H., Toepfer, A., Jakubietz, R. G., Gollwitzer, H., Rechl, H., von Eisenhart-Rothe, R., & Rudert. M. (2012). Proximal tibial replacement and alloplastic reconstruction of the extensor mechanism after bone tumor resection [in German]. Operative Orthopädie und Traumatologie, 24, 247–262. doi: 10.1007/s00064-012-0187-2.
Shimose, S., Sugita, T., Kubo, T., Matsuo, T., & Ochi, M. (2005). Reconstructed patellar tendon length after proximal tibia prosthetic replacement. Clinical Orthopaedics and Related Research, 439(&NA;), 176–180. doi: 10.1097/01.blo.0000176150.16509.33
Colangeli, M., Donati, D., Benedetti, M. G., Catani, F., Gozzi, E., Montanari, E., & Giannini, S. (2007). Total knee replacement versus osteochondral allograft in proximal tibia bone tumours. International Orthopaedics, 31 (6), 823–829. doi: 10.1007/s00264-006-0256-y
Wunder, J. S., Leitch, K., Griffin, A. M., Davis, A. M., & Bell, R. S. (2001). Comparison of two methods of reconstruction for primary malignant tumors at the knee: A sequential cohort study. Journal of Surgical Oncology, 77 (2), 89–99. doi: 10.1002/jso.1076
Ayerza, M. A., Aponte-Tinao, L. A., Abalo, E., & Muscolo, D. L. (2006). Continuity and function of patellar tendon host-donor suture in tibial allograft. Clinical Orthopaedics and Related Research, 450, 33–38. doi: 10.1097/01.blo.0000229291.21722.b5
Chim, H., Tan, B., Tan, M. H., Tan, K., & Song, C. (2007). Optimizing the use of local muscle flaps for knee megaprosthesis coverage. Annals of Plastic Surgery, 59 (4), 398–403. doi: 10.1097/01.sap.0000258955.27987.17
El-Sherbiny M. 2008. Pedicled gastrocnemius flap: clinical application in limb sparing surgical resection of sarcoma around the knee region and popliteal fossa. Journal of the Egyptian National Cancer Institute, 20 (2), 196–207.
Gosheger, G., Hillmann, A., Lindner, N., R??dl, R., Hoffmann, C., Borger, H., & Winkelmann, W. (2001). Soft tissue reconstruction of megaprostheses using a Trevira Tube. Clinical Orthopaedics and Related Research, 393, 264–271. doi:10.1097/00003086-200112000-00030
Kendall, S., Singer, G., Briggs, T., & Cannon, S. (2000). A functional analysis of massive knee replacement after extra-articular resections of primary bone tumors. The Journal of Arthroplasty, 15 (6), 754–760. doi: 10.1054/arth.2000.8104
Tan, P., Yong, B., Wang, J., Huang, G., Yin, J., Zou, C., & Shen, J. (2012). Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. European Journal of Surgical Oncology (EJSO), 38 (12), 1171–1177. doi: 10.1016/j.ejso.2012.07.003
Titus, V., & Clayer, M. (2008). Protecting a patellar ligament reconstruction after proximal tibial resection: a simplified approach. Clinical Orthopaedics and Related Research, 466 (7), 1749–1754. doi: 10.1007/s11999-008-0239-y
Wang, T. Y., Dormans, J. P., & Chang, B. (2012). Soft-tissue optimization of limb salvage with knee endoprosthesis. Annals of Plastic Surgery, 69 (5), 560–564. doi: 10.1097/sap.0b013e3182223d5b
Nasledov, A. SPSS 19: professional statistical data analysis. St. Petersburg: Peter, 2011. [in Russian]
Vyrva, O. Ye., & Skoryk, I. O. (2019). Modular endoprosthetics proximal tibia in case of giant cell tumor. Orthopaedics, Traumatology and Prosthetics, 1, 72–77. DOI: 10.15674/0030-59872019172-77. [in Ukrainian]
Gosheger, G., Hillmann, A., Lindner, N., R??dl, R., Hoffmann, C., B??rger, H., & Winkelmann, W. (2001). Soft tissue reconstruction of megaprostheses using a Trevira Tube. Clinical Orthopaedics and Related Research, 393, 264–271. doi: 10.1097/00003086-200112000-00030
Pilge, H., Holzapfel, B. M., Rechl, H., Prodinger, P. M., Lampe, R., Saur, U., & Gollwitzer, H. (2015). Function of the extensor mechanism of the knee after using the «patellar-loop technique» to reconstruct the patellar tendon when replacing the proximal tibia for tumour. The Bone & Joint Journal, 97-B (8), 1063–1069. doi: 10.1302/0301-620x.97b8.35440
Vyrva, O. Ye., Skoryk, I. O., Shevchenko, I. V., Malyk, R. V., Golovina, Ya. O., & Mikhanovskiy, D. O. (2019). Proximal tibia modular endoprosthetic replacement. analysis of complications. Orthopaedics, Traumatology and Prosthetics, 2, 67–73. doi: 10.15674/0030-59872019267-73. [in Ukrainian]
Vyrva, O. Ye. (2008). Reconstruction of soft tissues during modular megaendoprosthetics in patients with malignant bone tumors. Orthopedics, traumatology and prosthetics, 4, 54–61. [in Russian]
Vyrva, O. Ye. (2013). Modular individual endoprosthetics in the treatment of malignant tumors of the long bones: abstract of the dissertation of Doctor of Medical Sciences. Kyiv. [in Ukrainian]
Bus, M. P., Van de Sande, M. A., Fiocco, M., Schaap, G. R., Bramer, J. A., & Dijkstra, P. D. (2015). What are the long-term results of MUTARS® modular endoprostheses for reconstruction of tumor resection of the distal femur and proximal tibia? Clinical Orthopaedics and Related Research®, 475 (3), 708–718. doi: 10.1007/s11999-015-4644-8
Copyright (c) 2020 Oleg Vyrva
This work is licensed under a Creative Commons Attribution 4.0 International License.