title: A new technique using mesh for extensor reconstruction after proximal tibial resection.
abstract: BACKGROUND
  Proximal tibial reconstruction following wide resection in both malignant and benign tumors presents difficulties mainly due to both patellar tendon reconstruction and high risk of infection. The purpose of this study is to determine the efficacy of a new technique using a mesh for extensor reconstruction.
  
  
  METHODS
  We retrospectively reviewed nine consecutive patients who underwent resection of the proximal tibia with prosthetic reconstruction and reconstruction of the extensor using a mesh between 2009 and 2012. The surgical technique included the attachment of the mesh to the tibial component with a band of meshes looped over the patella and a gastrocnemius flap for coverage.
  
  
  RESULTS
  One patient had an above-the-knee amputation due to infection. Eight patients were followed up for 33 months (range, 20-50). In the eight patients, extensor lag had a mean of 5° (range, 0 to 20). Active flexion had a mean of 96.25° (range, 80 to 120) and ISOLS scores had a mean of 21/30 (range, 18 to 26). All patients were able to ambulate without crutches at the latest follow-up.
  
  
  CONCLUSIONS
  Extensor lag was significantly less compared to previous reports. No complications were observed in eight patients. Utilization of the mesh for extensor reconstruction after the proximal tibial resection is a simple, reliable and successful method.
authors.affiliation: Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Ichikawa
authors.affiliation: Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, Japan. Electronic address: smatsumoto@jfcr.or.jp.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoji
authors.affiliation: Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ae
authors.affiliation: Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Tanizawa
authors.affiliation: Department of Orthopaedic Surgery, Cancer Institute Hospital for Japanese Foundation for Cancer Research, Japan.
authors.forename: Tabu
authors.initials: T
authors.lastname: Gokita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D013977:Tibia / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bone tumor; Endoprosthesis; Extensor mechanism; Mesh; Proximal tibia