Use of Distal Femoral Osteoarticular Allografts in Limb Salvage Surgery by D. Luis Muscolo, Miguel A. Ayerza, Luis A. Aponte-Tinao, and Maximiliano Ranalletta.

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Presentation transcript:

Use of Distal Femoral Osteoarticular Allografts in Limb Salvage Surgery by D. Luis Muscolo, Miguel A. Ayerza, Luis A. Aponte-Tinao, and Maximiliano Ranalletta J Bone Joint Surg Am Volume 88(1 suppl 2): September 1, 2006 ©2006 by The Journal of Bone and Joint Surgery, Inc.

Axial computed tomography scan of a distal femoral allograft prior to implantation that shows the measurement of the maximum total width and the anteroposterior width of the medial and lateral condyles. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Axial computed tomography scan of a distal femoral allograft prior to implantation that shows the measurement of the width of the intercondylar notch. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

A long midline incision is made, beginning in the mid-part of the thigh. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Wide exposure of the distal part of the femur is achieved after a medial parapatellar arthrotomy is performed and the patella is everted. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The level of the femoral osteotomy is marked on the basis of the preoperative imaging studies. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The femoral osteotomy is performed after the posterior and medial structures have been protected. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The popliteal vessels, as well as the geniculate vessels, are seen prior to ligation. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The distal part of the femur is passed from the operative field, showing the osteoarticular defect. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The donor graft, after it has been thawed, showing both cruciate ligaments, the posterior capsule, and both collateral ligaments available for joint reconstruction. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

After tumor resection, a suture is placed in each cruciate and collateral ligament and in the popliteal tendon. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

After resection of the tumor, the distal femoral transplant is inspected to confirm that the size is appropriate and that no degenerative changes are present. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

In order to avoid varus-valgus malalignment, the graft and the native femur are placed on the back-table surface to compare their anatomical axes. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The diaphysis of the graft and that of the native femur have a similar size and shape. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The graft fits well to the diaphyseal osteotomy of the recipient femur. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The osteotomy surfaces between the host and the donor bone are in close apposition with adequate compression after internal fixation. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The knee is flexed to allow joint reconstruction after internal fixation of the osteotomy. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The distal femoral allograft is placed with the knee flexed to allow joint reconstruction. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The posterior cruciate ligament of the host is repaired to the corresponding allograft tissue. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The knee is reduced in the flexed position after posterior cruciate ligament reconstruction. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Reconstruction of the posterior cruciate ligament. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The suture used to reconstruct the cruciate ligaments. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The posterior capsule is repaired from posterior to anterior before the posterior cruciate ligament repair is secured. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The anterior cruciate ligament reconstruction is performed. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The anterior cruciate ligament is reconstructed after the posterior capsule and posterior cruciate ligament have been repaired. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior radiograph, made four years after tumor resection and osteoarticular allografting of the distal part of the femur, shows healing of the osteotomy site and adequate joint congruence. D. Luis Muscolo et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.