Extraarticular knee resection for sarcomas with preservation of the extensor mechanism: surgical technique and review of cases.

Abstract

Sarcomas in or contaminating the knee are rare but extremely challenging to treat. Complete resection of the joint is necessary, and often the entire extensor mechanism is removed as well. Reconstruction of the knee is challenging, and the resulting function may be compromised. We describe a surgical technique of extraarticular resection of the knee while preserving the extensor mechanism combined with prosthetic reconstruction. The medial and lateral retinaculum is prepared such that it allows extraarticular placement of K-wires that are driven through the patella and the proximal tibia, serving as in situ guides for the osteotomies. We retrospectively reviewed 11 patients with sarcomas contaminating the knee. The minimum followup was 14 months (mean, 38 months; range, 14-80 months). At last followup patients had a mean flexion of 88° (range, 65°-120°). We observed no complications related to the extensor mechanism, and there was one local recurrence. We believe extraarticular resection of the knee with preservation of the extensor mechanism is a reasonable treatment option for intraarticular sarcomas with functional scores comparable to those for patients having intraarticular resections. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.