Aims. Reconstruction of soft tissues and preservation of the extensor mechanism integrity provide a major challenge following resection of the proximal tibia tumours. We propose a novel surgical technique for neopatellar ligament reconstruction using hamstring tendon in proximal tibia tumour cases. This study details the surgical technique, early clinical and radiological outcomes, and the potential long-term benefits of this innovative reconstructive approach following proximal tibia megaprosthesis implantation. Methods. This study included 15 patients with proximal tibia tumours treated at orthopaedic oncology unit in Gujarat Cancer and Research Institue (GCRI), Ahmedabad, India. Surgical procedures included resecting the proximal tibia tumour, implanting a megaprosthesis, and using hamstring tendons to reconstruct the extensor mechanism by the neopatellar ligament. Autologous hamstring tendons (gracilis and semitendinosus) harvested from the ipsilateral leg were used and these tendons were braided together with a nonabsorbable suture and threaded through the remaining patellar tendon. The braided tendons were then secured to the holes in the tibial tuberosity of the proximal tibia megaprosthesis implant XLO (Ortho Life Systems, India) using nonabsorbable fibre wire sutures FiberWire (Arthrex, USA). The tension in the tendons was optimized and the sutures were tightened with the knee in full extension and the implant with neopatellar ligament were covered by medial gastrocnemius muscle flap. The mean follow-up period was 19 months (13 to 24), the mean age of the study group was 24.6 years (14 to 44), and it included 11 males and four females. Results. The histopathological diagnosis was osteosarcoma (eight patients), Ewing’s sarcoma (four patients), and giant cell tumours (three patients). The mean surgical duration was 3.2 hours (2.5 to 4.2) and the mean blood loss was 250 ml (150 to 450).Wound infection was found in three cases, which was managed with debridement and antibiotics. None of the patients had a local recurrence at the latest follow-up. The mean active knee flexion was 92° (85° to 105°), with an extensor lag of 4.6° (0° to 10°). The mean patella height preoperatively was 4.5 cm (4.3 to 5.1), with a patella tendon length of 4.7 cm (4.3 to 5.68). The mean preoperative patella height-to-patella tendon length ratio was 0.96 (0.89 to 1.02). Postoperatively (at 12 months), the mean patella tendon length was 4.4 cm (4.1 to 5.1), with a patella height-to- patella tendon length ratio of 1.04 (1 to 1.14). Follow-up radiological examinations showed that the neopatellar tendon had integrated satisfactorily, with no obvious signs of graft rupture or elongation.The mean Musculoskeletal Tumor Society score was 24 (22 to 27). Conclusion. This study presents Salunke’s Gujarat Cancer and Research Institute (GCRI) novel approach using hamstring tendons for neopatellar ligament reconstruction in proximal tibia megaprosthesis which successfully restores the knee's extensor mechanism. This technique provides an effective reconstructive option and preserving flexion, extension, and minimizing extensor lag. Additionally, the surgical steps are easily reproducible. Early radiological evaluations in this study demonstrated no evidence of patella alta or baja, though long-term follow-up is recommended. Cite this article: Bone Jt Open 2025;6(3):342–351

Aims

The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.

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Limb salvage surgery (LSS) is the primary treatment option for primary bone malignancy. It involves the removal of bone and tissue, followed by reconstruction with endoprosthetic replacements (EPRs) to prevent amputation. Trabecular metal (TM) collars have been developed to encourage bone ingrowth (osseointegration (OI)) into EPRs. The primary aim of this study was to assess whether OI occurs when TM collars are used in EPRs for tumour.

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To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs.

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Surgical limb sparing for knee-bearing paediatric bone sarcoma is considered to have a clinically significant influence on postoperative function due to complications and leg-length discrepancies. However, researchers have not fully evaluated the long-term postoperative functional outcomes. Therefore, in this study, we aimed to elucidate the risk factors and long-term functional prognosis associated with paediatric limb-sparing surgery.