Free patellar graft for the reconstruction of juxtaarticular defects in the treatment of giant-cell tumors.

The patella may solve the problem of an osteocartilaginous autograft for the articular reconstruction of the knee after resection of certain bone neoplasms. Such a solution may be adopted mainly after the resection of tumors that have attacked part of the tibial plate or that have necessitated the removal of the tibial plate to ensure a radical procedure. The cartilaginous surface of either one or both of the patellar articular facets is well suited for restoring the continuity of the tibial articular surface lost through resection. Furthermore, all of the remaining part of the patella provides an excellent graft for replacing the underlying bone loss. This is sometimes sufficient in itself; at times, other bone grafts are required. In both cases, patellectomy is the preliminary procedure and is performed on the same side where tibial resection will be done immediately afterward. Using this procedure, eight cases of giant-cell tumor on the proximal extremity of the tibia and one case on the distal epiphysis have been treated. Consolidation, facilitated by a firm metal osteosynthesis, was rapid. The long-term results were excellent; there were no local recurrences of the tumor, and knee joint function was preserved with values only slightly below normal, even though roentgenograms showed signs of arthrosis.