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Bone Tumors Around the Knee

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Joint Preservation in the Adult Knee

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Abstract

Bone tumors are commonly located around the knee, in the distal femur and proximal tibia and less frequently in the proximal fibula and patella. Treatment of bone tumors depends on the histological grade, the size and location of the tumor and the characteristics of the patient. Generally, benign bone tumors are adequately treated by either an intralesional or a marginal resection. To reduce the risk of recurrence, the intralesional resection may be extended with mechanical, chemical, and thermal adjuncts. Primary bone sarcomas and some aggressive benign tumors require a wide resection. Limb salvage principles are largely employed if neurovascular structures can be preserved and a level of function maintained. After tumor resection with a wide margin, the defect left poses a reconstructive challenge. In this chapter, we will refer to bone tumors that most frequently arise around the knee and may affect adult population. First, we consider the basic characteristics of these tumors and then the surgical treatment, focusing in those techniques that preserve the joint.

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References

  1. Unni K (1996) Dahlin’s bone tumors: general aspects and data on 11,087 cases, 5th edn. Lippincott-Raven, Philadelphia

    Google Scholar 

  2. Schajowicz F (1994) Tumors and tumor-like lesions of bone and joints. Pathology, Radiology and Treatment. Springer, New York

    Book  Google Scholar 

  3. Campanacci M (1999) Bone and soft tissue tumors. Springer, New York

    Book  Google Scholar 

  4. Fletcher CDM, Unni KK, Mertens F (2002) WHO classification of tumours of soft tissue and bone. IARC Press, Lyon

    Google Scholar 

  5. Resnick DR, Greenway GD (2002) Diagnosis of bone and joint disorders, 4th edn. Saunders, Philadelphia

    Google Scholar 

  6. Ramappa AJ, Lee FYI, Tang P, Carlson JR, Gebhardt MC, Mankin HJ (2000) Chondroblastoma of bone. J Bone Joint Surg Am 82-A:1140–1145

    Article  CAS  PubMed  Google Scholar 

  7. Martel Villagrán J, Bueno Horcajadas A, Ortiz Cruz EJ (2009) Percutaneous radiofrequency ablation of benign bone tumors: osteoid osteoma, osteoblastoma, and chondroblastoma. Radiologia 51:549–558

    Article  PubMed  Google Scholar 

  8. Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH (2000) Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 20:1407–3144

    Article  CAS  PubMed  Google Scholar 

  9. Schwartz HS, Zimmerman NB, Simon MA, Wroble RR, Millar EA, Bonfiglio M (1987) The malignant potential of enchondromatosis. J Bone Joint Surg Am 69:269–274

    Article  CAS  PubMed  Google Scholar 

  10. Ferrer-Santacreu EM, Ortiz-Cruz EJ, González-López JM, Pérez Fernández E (2012) Enchondroma versus low-grade chondrosarcoma in appendicular skeleton: clinical and radiological criteria. J Oncol 2012:437958. doi:10.1155/2012/437958, 6 pages

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ (1998) Percutaneous radiofrecuency coagulation of osteoide osteoma compared with operative treatment. J Bone Joint Surg Am 80-A:815–821

    Article  Google Scholar 

  12. Siebenrock KA, Unni KK, Rock MG (1998) Giant cell tumour of bone metastasizing to the lungs. A long-term follow-up. J Bone Joint Surg Br 80:43–47

    Article  CAS  PubMed  Google Scholar 

  13. Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G et al (2008) Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol 134:969–978

    Article  CAS  PubMed  Google Scholar 

  14. Xu BF, Adams B, Yu XC, Xu M (2013) Denosumab and giant cell tumour of bone- a review and future management considerations. Curr Oncol 20:442–447

    Article  Google Scholar 

  15. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhard MC (2005) Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 23:6756–6762

    Article  PubMed  Google Scholar 

  16. Aarons C, Potter K, Adams SC, Pitcher D, Temple T (2009) Extended intralesional treatment versus resection of low-grade chondrosarcomas. Clin Orthop Relat Res 467:2105–2111

    Article  PubMed  PubMed Central  Google Scholar 

  17. Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120

    Google Scholar 

  18. Fraquet N, Faizon G, Rosset P, Phillipeau JM, Waast D, Gouin F (2009) Long bones giant cells tumors: treatment by curetage and cavity filling cementation. Orthop Traumatol Surg Res 95:402–406

    Article  CAS  PubMed  Google Scholar 

  19. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM, Canadian Sarcoma Group (2002) Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res 397:248–258

    Article  Google Scholar 

  20. Algawahmed H, Turcotte R, Farrokhyar F, Ghert M (2010) High-speed burring with and without the use of surgical adjuvants in the in-tralesional management of giant cell tumor of bone: a systematic review and meta-analysis. Sarcoma 2010:586090. doi:10.1155/2010/586090, 5 pages

    Article  PubMed  PubMed Central  Google Scholar 

  21. Campanacci M, Capanna R, Fabbri N, Bettelli G (1990) Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chir Organi Mov 75(Suppl 1):212–213

    CAS  PubMed  Google Scholar 

  22. Ayerza MA, Aponte-Tinao LA, Farfalli GL, Restrepo CA, Muscolo DL (2009) Joint preservation after extensive curettage of knee giant cell tumors. Clin Orthop Realat Res 467:2845–2851

    Article  Google Scholar 

  23. Imran H (2009) Effect of time to resumption of chemotherapy after definitive surgery on prognosis for non-metastatic osteosarcoma. J Bone Joint Surg Am 91:604–612

    Article  PubMed  PubMed Central  Google Scholar 

  24. Musculo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M (2004) Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg Am 86-A:2686–2693

    Article  Google Scholar 

  25. Weitao Y, Qiqing C, Songtao G, Jiaqiang W (2012) Epiphysis preserving operations for the treatment of lower limb malignant bone tumors. Eur J Surg Oncol 38:1165–1170

    Article  CAS  PubMed  Google Scholar 

  26. Deijkers RLM, Bloem RM, Kroon HM, van Lent JB, Brand R, Taminiau AHM (2005) Epidiaphyseal versus other intercalary allografts for tumors of the lower limb. Clin Orthop Relat Res 439:151–160

    Article  CAS  PubMed  Google Scholar 

  27. Aponte-Tinao L, Ayerza MA, Muscolo DL, Farfalli GL (2015) Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res 473:1789–1796

    Article  PubMed  Google Scholar 

  28. Agarwal M, Puri A, Gulia A, Reddy K (2010) Joint-sparing or physeal-sparing diaphyseal resections. The challenge of holding small fragments. Clin Orthop Relat Res 468:2924–2932

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tsuchiya H, Abdel-Wanis ME, Tomita K (2006) Reconstruction after excision of juxta-articular osteosarcoma around the knee: a new classification system. Anticancer Res 26:447–454

    PubMed  Google Scholar 

  30. Hoffer FA, Nikanorov AY, Reddick WE, Bodner SM, Xiong X, Jones-Wallace D, Gronemeyer SA, Rao BN, Kauffman WM, Laor T (2000) Accuracy of MR imaging for detecting epiphyseal extension of osteosarcoma. Pediatr Radiol 30:289–298

    Article  CAS  PubMed  Google Scholar 

  31. Aponte-Tinao L, Farfalli GL, Ritacco LE et al (2012) Intercalary femur allografts are an acceptable alternative after tumor resection. Clin Orthop Relat Res 470:728–734

    Article  PubMed  Google Scholar 

  32. Avedian RS, Haydon RC, Peabody TD (2010) Multiplanar osteotomy with limited wide margins: a tissue preserving surgical technique for high-grade bone sarcomas. Clin Orthop Relat Res 468:2754–2764

    Article  PubMed  PubMed Central  Google Scholar 

  33. Brigman B, Hornicek FJ, Gebhardt MC, Mankin HJ (2004) Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res 421:232–239

    Article  Google Scholar 

  34. Ortiz-Cruz EJ, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ (1997) The results of transplantation of intercalary allografts after resection of tumors: a long-term follow-up study. J Bone Joint Surg Am 79:97–106

    Article  CAS  PubMed  Google Scholar 

  35. Mankin HJ, Hornicek FJ, Raskin KA (2005) Infection in massive bone allografts. Clin Orthop Relat Res 432:210–216

    Article  Google Scholar 

  36. Fuchs B, Ossendorf C, Leerapun T, Sim FH (2008) Intercalary segmental reconstruction after bone tumor resection. Eur J Surg Oncol 34:1271–1276

    Article  CAS  PubMed  Google Scholar 

  37. Farfalli GL, Aponte-Tinao L, Lopez-Millán L et al (2012) Clinical and functional outcomes of tibial intercalary allografts after tumor resection. Orthopedics 35:391–396

    Article  Google Scholar 

  38. Hsu RW, Wood M, Sim FH, Chao EY (1997) Free vascularized fibular grafting for reconstruction after tumour resection. J Bone Joint Surg Br 79:36–42

    Article  PubMed  Google Scholar 

  39. Zaretski A, Amir A, Meller I, Leshem D, Kollender Y, Barnea Y, Bickels J, Shpitzer T, Ad-El D, Gur E (2004) Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg 113:1989–2000

    Article  PubMed  Google Scholar 

  40. Hariri A, Mascard E, Atlan F et al (2010) Free vascularised fibular graft for reconstruction of defects of the lower limb after resection of tumour. J Bone Joint Surg Br 92-B:1574–1579

    Article  Google Scholar 

  41. Hilven PH, Bayliss L, Cosker T et al (2015) The vascularised fibular graft for limb salvage after bone tumour surgery. Bone Joint J 97:853–861

    Article  PubMed  Google Scholar 

  42. Eward WC, Kontogeorgakos V, Levin LS, Brigman BE (2010) Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res 468:590–598

    Article  PubMed  Google Scholar 

  43. Niethard M, Tiedke C, Andreou D, et al (2013) Bilateral fibular graft: biological reconstruction after resection of primary malignant bone tumors of the lower limb. Sarcoma http://dx.doi.org/10.1155/2013/205832

  44. Friedrich JB, Moran SL, Bishop AT, Wood CM, Shin AY (2008) Free vascularized fibular graft salvage of complications of long bone allograft after tumor reconstruction. J Bone Joint Surg Am 90:93–100

    Article  PubMed  Google Scholar 

  45. Capanna R, Bufalini C, Campanacci M (1993) A new technique for reconstructions of large metadiaphyseal bone defects: a combined graft (allograft shell plus vascularized fibula). Orthop Traumatol 2:159–177

    Article  Google Scholar 

  46. Capanna R, Campanacci DA, Belot N, Beltrami G, Manfrini M, Innocenti M, Ceruso M (2007) A new reconstructive technique for intercalary defects of long bones: the associations of massive allograft with vascularized fibular autograft: long-term results and comparison with alternative techniques. Orthop Clin North Am 38:51–60

    Article  PubMed  Google Scholar 

  47. Abed YY, Beltrami G, Campanacci DA et al (2009) Biological reconstruction after resection of bone tumours around the knee. Long-term follow-up. J Bone Joint Surg Br 9:1366–1372

    Article  Google Scholar 

  48. Hayashi K, Araki N, Koizumi M, Suzuki O, Seo Y, Naka N et al (2015) Long-term results of intraoperative extracorporeal irradiation of autogenous bone grafts on primary bone and soft tissue malignancies. Acta Oncol 54(1):138–141. doi:10.3109/0284186X.2014.930172

    Article  PubMed  Google Scholar 

  49. Khattak MJ, Umer M, Umar M (2006) Autoclaved tumor bone for reconstruction: an alternative in developing countries. Clin Orthop Relat Res 447:138–144

    Article  PubMed  Google Scholar 

  50. Sabo D, Brocai DRC, Eble M, Wannenmacher M, Ewerbeck V (2000) Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint. J Bone Joint Surg Br 82:276–282

    Article  CAS  PubMed  Google Scholar 

  51. Ogura K, MiyamotoS, Sakuraba M, Fujiwara T, et al (2015) Clinical study intercalary reconstruction after wide resection of malignant bone tumors of the lower extremity using a composite graft with a devitalized autograft and a vascularized fibula. Sarcoma http://dx.doi.org/10.1155/2015/861575

  52. Manabe J, Ahmed AR, Kawaguchi N, Matsumoto S, Kuroda H (2004) Pasteurized autologous bone graft in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res 419:258–266

    Article  Google Scholar 

  53. Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S (1997) Limb salvage using distraction osteogenesis: a classification of the technique. J Bone Joint Surg Br 79:403–411

    Article  CAS  PubMed  Google Scholar 

  54. Erler K, Yildiz C, Baykal B, Atesalp AS, Ozdemir MT, Basbozkurt M (2005) Reconstruction of defects following bone tumor resections by distraction osteogenesis. Arch Orthop Trauma Surg 125:177–183

    Article  PubMed  Google Scholar 

  55. Spiegelberg BGI, Sewell MD, Aston WJS et al (2009) The early results of joint-sparing proximal tibial replacement for primary bone tumours, using extracortical plate fixation. J Bone Joint Surg Br 91:1373–1377

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, “La Paz” University Hospital-IdiPaz, Paseo de la Castellana 261, 28046, Madrid, Spain

    Manuel Peleteiro-Pensado, Irene Barrientos-Ruiz & Eduardo J. Ortiz-Cruz

Authors
  1. Manuel Peleteiro-Pensado
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  2. Irene Barrientos-Ruiz
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  3. Eduardo J. Ortiz-Cruz
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Corresponding author

Correspondence to Manuel Peleteiro-Pensado .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London, Institute of Orthopaedics and Musculoskeletal Science, London, United Kingdom

    Alexander D. Liddle

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Peleteiro-Pensado, M., Barrientos-Ruiz, I., Ortiz-Cruz, E.J. (2017). Bone Tumors Around the Knee. In: Rodríguez-Merchán , E., Liddle, A. (eds) Joint Preservation in the Adult Knee. Springer, Cham. https://doi.org/10.1007/978-3-319-41808-7_13

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  • DOI: https://doi.org/10.1007/978-3-319-41808-7_13

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