title: Staged lengthening and reconstruction for children with a leg-length discrepancy after excision of an osteosarcoma around the knee.
abstract: OBJECTIVE
  Children treated for osteosarcoma around the knee often have a substantial leg-length discrepancy at skeletal maturity. The aim of this study was to investigate the results of staged skeletal reconstruction after a leg lengthening procedure using an external fixator in these patients.
  
  
  METHODS
  We reviewed 11 patients who underwent staged reconstruction with either an arthroplasty (n = 6) or an arthrodesis (n = 5). A control group of 11 patients who had undergone wide excision and concurrent reconstruction with an arthroplasty were matched for gender, location, and size of tumour. We investigated the change in leg-length discrepancy, function as assessed by the Musculoskeletal Tumor Society Scale (MSTS) score and complications.
  
  
  RESULTS
  A mean 5.2 cm (1.7 to 8.9) of lengthening was achieved. The mean MSTS scores significantly improved after staged reconstruction (p = 0.003) but were still worse than those of the control group (p = 0.049). However, the MSTS scores of the arthroplasty subgroup were comparable with those of the controls, although the extensor lag was greater and the range of movement was less. The patient group experienced more complications, but all of these resolved.
  
  
  CONCLUSIONS
  Approximately 5 cm of lengthening and significant functional improvement can be achieved by staged reconstruction and lengthening, without major complications. Although it has limitations, this method of treatment seems to be a satisfactory surgical option for growing children with a significant leg-length discrepancy after excision of an osteosarcoma around the knee. Cite this article:Bone Joint J2017;99-B:401-8.
authors.affiliation: University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea.
authors.forename: S
authors.initials: S
authors.lastname: Kang
authors.affiliation: University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Park
authors.affiliation: University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea.
authors.forename: S-S
authors.initials: SS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods; D001852:Bone Lengthening / Q000009:adverse effects / Q000379:methods*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000601:surgery*; D020127:Recovery of Function
keywords: Arthrodesis; Ilizarov; Leg-length discrepancy; Lengthening; Musculoskeletal Tumor Society; Osteosarcoma