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

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 AmVolume 88(1 suppl 2):305-321

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;88:305-321


Axial computed tomography scan of a distal femoral allograft prior to implantation that shows the measurement of the width of the intercondylar notch.



A long midline incision is made, beginning in the mid-part of the thigh.



Wide exposure of the distal part of the femur is achieved after a medial parapatellar arthrotomy is performed and the patella is everted.



The level of the femoral osteotomy is marked on the basis of the preoperative imaging studies.



The femoral osteotomy is performed after the posterior and medial structures have been protected.



The popliteal vessels, as well as the geniculate vessels, are seen prior to ligation.



The distal part of the femur is passed from the operative field, showing the osteoarticular defect.



The donor graft, after it has been thawed, showing both cruciate ligaments, the posterior capsule, and both collateral ligaments available for joint reconstruction.



After tumor resection, a suture is placed in each cruciate and collateral ligament and in the popliteal tendon.



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.



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.



The diaphysis of the graft and that of the native femur have a similar size and shape.



The graft fits well to the diaphyseal osteotomy of the recipient femur.



The osteotomy surfaces between the host and the donor bone are in close apposition with adequate compression after internal fixation.



The knee is flexed to allow joint reconstruction after internal fixation of the osteotomy.



The distal femoral allograft is placed with the knee flexed to allow joint reconstruction.



The posterior cruciate ligament of the host is repaired to the corresponding allograft tissue.



The knee is reduced in the flexed position after posterior cruciate ligament reconstruction.



Reconstruction of the posterior cruciate ligament.



The suture used to reconstruct the cruciate ligaments.



The posterior capsule is repaired from posterior to anterior before the posterior cruciate ligament repair is secured.



The anterior cruciate ligament reconstruction is performed.



The anterior cruciate ligament is reconstructed after the posterior capsule and posterior cruciate ligament have been repaired.



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.



Documents

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