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Updated: Jun 25, 2026
Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model
Published on: August 13, 2017
Novel limb-sparing technique for proximal tibial osteosarcoma: Patella Chevron Osteotomy with pedicle cryotherapy and
Muhammad Naseh Sajadi Budi1, Bangkit Primayudha1, Yudi Purnama Nugraha2
1Division of Oncology, Department of Orthopaedic and Traumatology, Faculty of Medicine Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia.
Introduction And Importance:
Osteosarcoma of the proximal tibia presents a significant challenge in pediatric orthopedic oncology, particularly concerning limb salvage and functional outcomes. Traditional management often involves endoprosthetic reconstruction, which can lead to complications and revisions, especially in young patients.
Case Presentation:
We report the case of a 16-year-old male of Asian Sundanese ethnicity presenting with a grade 3 conventional osteosarcoma of the right proximal tibia. Following neoadjuvant chemotherapy per the EURAMOS protocol, the patient underwent a novel limb-sparing procedure combining patella chevron osteotomy, pedicle cryotherapy, and bone-on-polyethylene reconstruction. This approach was chosen to preserve the extensor mechanism, minimize recurrence through in-situ devitalization, and avoid costly endoprostheses while ensuring joint stability. The chevron osteotomy preserved the patella and extensor function, crucial for postoperative mobility. Pedicle cryotherapy allowed effective tumor cell devitalization while conserving native bone stock. Bone-on-polyethylene reconstruction offered a durable, cost-effective alternative suitable for skeletally immature patients. Post-operatively, the patient demonstrated satisfactory healing and joint stability. Histopathology confirmed clear resection margins.
Clinical Discussion:
Chemotherapy resumed two weeks post-surgery. At 12-month follow-up, the patient remained recurrence-free, with good functional outcomes and minimal limb length discrepancy. This technique highlights a promising alternative to traditional endoprosthetic reconstruction in pediatric patients.
Conclusion:
This case report presents a novel surgical approach for proximal tibial osteosarcoma in a pediatric patient. The technique-combining patella chevron osteotomy, pedicle cryotherapy, and bone-on-polyethylene reconstruction-demonstrated excellent oncologic control, functional preservation, and growth potential. It may offer improved long-term outcomes and reduce revision surgery rates, particularly in resource-limited settings.
