Protecting a Patellar Ligament Reconstruction after Proximal Tibial Resection: A Simplified Approach

Limb salvage in tumor surgery has encouraged the development of megaprostheses. However, reattaching the ligamentum patellae poses a particular problem: avulsion and/or extensor lag may lead to poor function. We describe a new technique of patellar ligament reconstruction. The technique involves reattachment of the patellar ligament to the tibial tuberosity of the proximal tibial megaprosthesis, which has a porous surface created, and the repair is protected with a cerclage wire through the patella and the prosthesis. In 10 consecutive patients, the range of motion averaged 95° (median, 90°; range, 70°–120°), and the mean extension lag averaged 4° (median, 0°; range, 0°–20°). We had one case of patellar ligament avulsion. This technique resulted in good quadriceps function and a low incidence of complications.