Reconstruction of the Extensor Apparatus Using a Hybrid Augment with Polyethylene Mesh and Fascia Lata Allograft: Report of a Case with Patellar Gigant Cell Tumor of the Bone.

Abstract

<h4>Introduction</h4>The extensor apparatus of the knee can be thought of a chain that transmits the muscular strength developed by the quadriceps muscles to the proximal tibia. This complex is essential to allow the extension of the tibia over the femur, being essential to provide knee mobility and stability. In case of lesions which irreparably damage the patella, such as a locally aggressive bone tumor, it is necessary to restore both the apparatus' anatomical continuity and its strength.<h4>Case report</h4>A 67-years-old Caucasian woman developed atraumatic swelling and soreness in her left knee. X-rays and MRI images evidenced an osteolytic degeneration of the patella. A diagnosis of Gigant cell tumor of bone was made with a needle biopsy. We performed an en bloc resection of the patella and replaced it with a composite augment made with a polypropylene mesh and a fascia lata allograft. No complication was observed. In her latest follow-up, our patient did not have any extension lag and quadriceps strength was completely restored.<h4>Conclusion</h4>The combination of internal layers of polypropylene surgical mesh and a surface allogenic graft can provide good mechanical performances for patients who underwent patellectomy due to a locally aggressive tumor.