• The Journal of the Korean bone and joint tumor society
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• v.10 no.1
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• pp.1-12
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• 2004

Purpose: The current study was performed to analyze the oncological and functional results, and the patient, the limb and the prosthesis survival of osteosarcoma around the knee in children according to the treatment options. Materials and Methods: From 1982 to 2002, 63 patients with osteosarcoma around the knee underwent surgical treatments before 16 years of age. Surgical treatment options were amputation, endoprosthetic replacement, and implantation of low heat-treated autogenous bone graft after wide resection of tumor. The mean age of patients was 11.5 years (4.4~16), and the mean follow-up period was 6.1 years (2.1~16.8). All patients had neoadjuvant and adjuvant chemotherapy. All endoprosthses were extendible types. Anatomical locations of osteosarcoma were distal femur in 40 patients, and proximal tibia in 23 patients. As regard to Enneking stage, 4 patients had stage $II_A$, 50 patients had stage $II_B$, and 9 patients had stage III tumors. Results: The 5 year survival rate of stage $II_B$ patients was 72.7% in amputation, 83.7% in endoprosthesis, and 100% in low heat-treated autogenous bone graft. The 5 year survival rate of salvaged limb was 84.4% in endoprosthesis, and 80% in low heat-treated autogenous bone graft. The survival rate of prosthesis was 92.7% at 5 years, 67.4% at 10 years in endoprosthesis, and 75% at 5 years in low heat-treated autogenous bone graft. Mean functional outcome scores were 8.7 points in amputation, 20.6 points in endoprosthesis, and 16 points in low heat-treated autogenous bone graft. Distant metastasis occurred 15.8% in amputation, 27% in endoprosthesis and local recurrence occurred 8.1% in endoprosthesis, 14.3% in low heat-treated autogenous bone graft. Major complications happened 26.3% in amputation, 35.1% in endoprosthesis, and 28.6% in low heat-treated autogenous bone graft. Conclusion: Limb salvage procedure had functionally better results than amputation in children with osteosarcoma around the knee. Reconstruction with endoprosthesis after resection of tumor had good results in children as adults. In certain circumstances as too small bone for endoprosthesis or minimal bony destruction or too skeletally immature patient, low heat-treated autogenous bone graft may be a good treatment option. Low heat-treated autogenous bone graft may be considered as not only a substitute for endoprosthesis but also a temporary method before endoprosthesis.

• The Journal of the Korean bone and joint tumor society
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• v.16 no.1
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• pp.1-7
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• 2010

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.81-87
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• 2007

Purpose: Chondroblastoma of bone is rare with the potential for local recurrence and metastasis. A retrospective review of 30 patients with chondroblastoma of bone treated at a single institution during a 24-year period was conducted to determine the clinical outcome and relevant prognostic factors. Materials and Methods: Thirty patients with biopsy-proven chondroblastoma of bone, treated between September of 1981 and September of 2005, were retrospectively reviewed. There were 16 men and 14 women with an average follow-up period of 7.2 years (range, 1.6~21.2). The most common sites were the distal femur (n=7), proximal humerus (n=6), proximal tibia (n=6) and proximal femur (n=4). The average age of the patients was 20 years (range, 12~47) with closed physes in 20 patients(67%.) Twenty-seven patients(90%) were treated by curettage of the tumor with or without bone grafting or cementing. Three patients(10%) were treated with en bloc resection. Clinical and pathological factors reported to be associated with poor outcome were analyzed. Results: Four local recurrences(13%) developed in postoperative 4, 6, 7 and 16 months. These patients underwent further curettage (once in 2 patients and twice 2) and had no further recurrence. All patients showed no evidence of disease at the final follow-up. Local recurrence developed in the two cases which removal of the tumor was incomplete. Curettage and bone-grafting (1) and cementing (1) were performed in the two other cases with local recurrences. In contrast, no local recurrences were observed in the 3 cases treated with en-bloc resection. The status of physes or the histologic presence of aneurysmal bone cyst, the anatomic location of the tumor did not affect local recurrence. Conclusion: Adequate removal of the tumor with aggressive curettage or en bloc resection seems to be necessary to prevent local recurrence in chondroblastoma. The status of physes, the histologic presence of aneurysmal bone cyst or the anatomic location of the tumor was not related with local recurrence.

• Journal of the Korean Orthopaedic Association
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• v.56 no.2
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• pp.134-141
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• 2021

Purpose: Patellar dislocations have a range of causes. This study examined the results of treatment aimed at balancing soft tissues around the patella. Materials and Methods: Thirty-two patellar dislocations in 28 patients (21 females and seven males) were examined. The mean patient age at the time of surgery was 11.5 years, and the mean follow-up period was 4.6 years. Dislocations were 19 chronic, six habitual, six congenital, and one acute. Soft tissue balancing surgery included lateral capsular release, medial capsular plication, and inferolateral transfer of the vastus medialis obliquus. Medial transfer of the patellar tendon, partial strip of the rectus femoris and patella tendon, and distal femoral osteotomy were also performed selectively. The preoperative Q angle, femoral anteversion angle, tibial external rotation angle, tibial tubercle-trochlear groove distance (TT-TG distance), mechanical femoral-tibial angle, and femoral trochlear dysplasia according to Dejour were measured, and the pre- and postoperative Lysholm-Tegner scores were used to analyze the clinical results. Results: The mean preoperative Q angle, TT-TG distance, femoral anteversion angle, tibial external rotation angle, mechanical femoraltibia angle, and Lysholm-Tegner score were 9.3°, 15.5 mm, 25.6°, 30.4°, 3.0°, and 75.8, respectively. Eleven patients had systemic ligament laxity with a Beighton score of five or more. Twenty-two patients had femoral trochlear dysplasia: four type A (3 patients), 16 type B (15 patients), one type C (1 patient), and four type D (3 patients). Of the 32 cases, 28 were corrected successfully by the first operation. Of four cases of postoperative subluxation, three were corrected by the second operation, and one of them was corrected after a third operation. The last patient is currently being followed-up. The mean Lysholm-Tegner score improved to 85.6 after the operation. Conclusion: Correcting all the causes of patella dislocation simultaneously is difficult. Nevertheless, satisfactory outcomes were obtained with soft tissue balancing surgery around the patella and a corrective osteotomy for an abnormal mechanical axis of the femur-tibia and torsion.