Graft of allogeneic knee extensor mechanism
in treatment of giant cell tumor of the patella
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Published:2019-11-12
Issue:
Volume:73
Page:581-587
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ISSN:0032-5449
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Container-title:Postępy Higieny i Medycyny Doświadczalnej
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language:
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Short-container-title:Postepy Hig Med Dosw
Author:
Dragan Szymon Ł.1, Kulej Mirosław1, Mucha Łukasz2, Morasiewicz Piotr1, Urbański Wiktor1, Dragan Barbara3, Wolańczyk Michał4, Dragan Szymon F.1
Affiliation:
1. Department and Clinic of Orthopaedics and Traumatology, Wroclaw Medical University, Wroclaw, Poland 2. Clinic of Orthopaedics and Traumatology, Wroclaw University Hospital, Wroclaw, Poland 3. Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland 4. Department of Radiology, Wroclaw Medical University, Wroclaw, Poland
Abstract
Introduction: Cancer of the patella is a rare condition. Giant cell tumor of the patella is an extremely rare and a difficult to solve therapeutic problem. Depending on the degree of bone destruction, it may cause significant knee joint dysfunction. It is assumed that surgery is the treatment of choice.
Material/Methods: This study presents an innovative treatment of a giant cell tumor of the patella in a 40-year-old male with significant dysfunction of the knee extensor mechanism. Complex therapy included neoadjuvant treatment using a human monoclonal antibody IgG2 that binds to RANKL (Denosumab) and follow-up allogeneic grafting of knee extension mechanism.
Results: Follow-up CTs showed correct positioning and healing of grafted knee extensor mechanism. Early functional outcome was perfect. Seven weeks after the surgery, reduction of pain, improvement of the contour of the joint, full active extension and flexion of 110° were noticed. Fifteen months after the surgery, the patient presented complete active extension and flexion of the knee joint, actively participated in professional life and CT tests did not reveal features of tumor recurrence.
Conclusions: Treatment of isolated giant cell tumor of the patella with destruction of patella and joint dysfunction does not have a clear solution in the available literature. Such a condition may also exclude traditional procedures. In such cases, grafting of the whole extensor mechanism appears to be the appropriate treatment.
Publisher
Walter de Gruyter GmbH
Subject
Infectious Diseases,Microbiology (medical)
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