[Subtotal Segment Resection, Augmenting Angle-Stable Plate Osteosynthesis and Allogenic Bone Graft as Treatment Option for Juxtacortical Osteosarcoma in the Knee Region]. / Subtotale Segmentresektion, augmentierende winkelstabile Plattenosteosynthese und allogene Spongiosaplastik als Therapieoption beim knienahen juxtakortikalen Osteosarkom.

Juxtacortical osteosarcomas are a group of rare primary bone tumours. They differ from medullary osteosarcomas in their anatomic location (outside of the corticalis), low metastasis rate and better prognosis. The only evidence-based treatment of juxtacortical osteosarcomas is the wide surgical resection. In this technical report we will introduce a new surgical technique, including the subtotal resection of the tumour-bearing bone segment, defect reconstruction by means of an augmenting fixed-angle plate osteosynthesis and homologous cancellous bone graft. If necessary, a subsequent plastic coverage of the soft tissue defect was performed. The technique will be presented by means of three illustrated cases of young patients with juxtacortical osteosarcomas in the proximity of the knee joint. Following diagnostic confirmation by means of an incision biopsy and tumour staging, the three patients underwent this new surgical technique. In the postoperative follow-up and re-staging, two to seven years after surgery, all patients were under complete remission, had functionally restored knee joints (Karnofsky score 90 % or higher) and showed good aesthetic results. The surgical technique described may therefore be an adequate alternative to the complete resection of the tumour-bearing bone segment with prosthetic reconstruction and should be considered on the basis of the illustrated functional results in individual cases.

[Surgical treatment of tibialis anterior tendon rupture]. / Operative Therapie der Tibialis-anterior-Sehnenruptur.

INTRODUCTION: Tibialis anterior tendon rupture is rare, with only a few cases and small series having been reported in the literature. In this article, cases reported in the literature from 1997-2012 are reviewed and patients treated by the author are presented. MATERIALS: Cases published from 1997-2012 needing surgical treatment for tibialis anterior tendon rupture were retrospectively reviewed. In all, 32 articles with a total of 44 reported cases and 5 patients from our own practice were included. Patient-specific data (e.g., age, trauma, secondary diagnosis, and time to surgery), surgical technique, operative result, and documented complications were also evaluated. RESULTS: The mean age (MA) of the patients (30 men and 19 women) undergoing treatment was 58 years. A total of 17 patients presented as a result of adequate trauma (MA 52) and 32 patients without or minor trauma (MA 62). In 16 patients (33 %), a primary tendon suture was selected, while in 11 patients (22 %) osseous refixation techniques were performed. In 21 patients (43 %), plastic reconstruction was necessary. Total recovery was observed in 69 % of patients (n = 34); 26 % (n = 13) had moderate limitations. Complications were reported in 12 % of cases (n = 6), thereof one re-rupture. CONCLUSION: Good to excellent results were observed in tibialis anterior tendon ruptures reconstruction. No associations between surgical treatment and outcome were observed. The selection of the surgical technique depended on rupture mechanism, location, size, tendon constitution, rupture age, and surgeon's experience.