DOS BULLETIN - Dansk Ortopædisk Selskab
DOS BULLETIN - Dansk Ortopædisk Selskab DOS BULLETIN - Dansk Ortopædisk Selskab
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 112 Metastatic pattern, local relapse and survival of patients with myxoid liposarcoma Hanna M Fuglø, Søren Daugaard, Michael M Petersen Department of Orthopaedic Surgery, Rigshospitalet; Department of Pathology, Rigshospitalet Background: Sarcomas are rare tumors accounting for approximately 1% of all malignant tumors in adults, and 4/5 are soft tissue sarcomas. In general the metastatic pattern of soft tissue sarcomas are hematogenic to the lungs, and the recommended follow-up for metastases in these patients is routine chest X-rays. Purpose: To assess the metastatic pattern of the histological subtype myxoid liposarcoma, and evaluate the metastases-free survival, local relapse-free survival and overall survival. Methods: Twenty-five patients (F/M = 12/13, mean age 50 (24-85) years) were diagnosed with a myxoid liposarcoma at the Department of Orthopaedic Surgery, Rigshospitalet from 1995-2004 (1995- 1999 (n=7), 2000-2004 (n=18)). In 2010 a retrospective review of patient files combined with an extraction of survival data from the CPR-registret were performed. The following parameters were recorded: tumor localization, size and depth; classification of tumor; surgical margin; type of treatment, type and time of follow-up; distant metastases; local relapse, and final health status (death/alive). Statistics: Kaplan-Meier survival analysis. Findings: Six patients had metastases during the observation period. Two patients had metastases at the time of diagnosis, while metastases occurred within 2-3 years in 3 patients and in one patient 11.9 years after the primary diagnosis. We found an unusual metastatic pattern since all metastases occurred at extra- pulmonary sites (intraabdominally/peritoneally, spine, chest wall, mediastinum, paravertebraly, and cutaneously). The probability for metastasis-free 5 and 10 years survival was 79%. Five patients had local relapse, and the first local relapse occurred within 2 years after surgery in 4 patients. The probability for 5 and 10 years local relapse-free survival was respectively 81% and 72 %. The probability for overall survival after 5 and 10 years was 72% and 68 % respectively. Conclusion: In this study the patients with myxoid liposarcoma had only extrapulmonary metastases, and no metastases of the lungs. Most local relapses and distant metastases occured within the first 2-3 years after surgery. We suggest that follow-up of patients suffering from myxoid liposarcoma should also include imaging of the abdomen/pelvis. 112
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 113 Medial patellafemoral ligament reconstruction results in good patient satisfaction. A retrospective study Jens Christian Pørneki, Siamak Bahari Background: Patellofemoral dislocations are common. In cases with recurrence or residual instability, surgical intervention is usually considered due to poor results with conservative and physiotherapeutic treatment. Numerous treatment protocols have been used to treat patellofemoral instability secondary to patella dislocation. Purpose: The aim of the study was to analyze the clinical outcome 12- 36 month after MPFL reconstruction according to patient satisfaction and re-dislocation. Methods: 26 patients (23 female and 3 men) age 14-31 with recurrence luxations of the patella were included. They all underwent MPFL- reconstruction from 2007 -2009. The patients were questioned by validated questionnaire (Kujala knee function score). Reconstruction was performed suturing the gracilis tendon autograft to the medial part of the patella with two anchors, and fixed at the anatomical MPFL insertion site on the medial femoral condyle with an interference screw. Findings: All included patients participated. No patella re-dislocation was reported. Subluxation occurred in 2 patients (8 %). 5 patients (20%) had chronic pain at follow-up. According to surgery description, these 5 patients had cartilage injury at the time of the reconstruction. The Kujala knee function score improved overall from 44 points (range, 15 to 65 points) to 83 points (range, 60 to 99 points). Conclusion: This study shows that MPFL reconstruction with gracilis tendon graft sutured to the medial part of the patella with two anchors provides good postoperative patellar stability and seems equal to other surgical techniques in terms of patient satisfaction. Postoperative pain seems to be related to the degree of patellofemoral cartilage injury found at surgery. 113
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2010-378_<strong>DOS</strong> nr. 3 2010 29/09/10 10:08 Side 113<br />
Medial patellafemoral ligament reconstruction results<br />
in good patient satisfaction. A retrospective study<br />
Jens Christian Pørneki, Siamak Bahari<br />
Background: Patellofemoral dislocations are common. In cases with<br />
recurrence or residual instability, surgical intervention is usually considered<br />
due to poor results with conservative and physiotherapeutic treatment.<br />
Numerous treatment protocols have been used to treat<br />
patellofemoral instability secondary to patella dislocation.<br />
Purpose: The aim of the study was to analyze the clinical outcome 12-<br />
36 month after MPFL reconstruction according to patient satisfaction<br />
and re-dislocation.<br />
Methods: 26 patients (23 female and 3 men) age 14-31 with recurrence<br />
luxations of the patella were included. They all underwent MPFL- reconstruction<br />
from 2007 -2009. The patients were questioned by validated<br />
questionnaire (Kujala knee function score). Reconstruction was performed<br />
suturing the gracilis tendon autograft to the medial part of the<br />
patella with two anchors, and fixed at the anatomical MPFL insertion<br />
site on the medial femoral condyle with an interference screw.<br />
Findings: All included patients participated. No patella re-dislocation<br />
was reported. Subluxation occurred in 2 patients (8 %). 5 patients (20%)<br />
had chronic pain at follow-up. According to surgery description, these 5<br />
patients had cartilage injury at the time of the reconstruction. The Kujala<br />
knee function score improved overall from 44 points (range, 15 to 65<br />
points) to 83 points (range, 60 to 99 points).<br />
Conclusion: This study shows that MPFL reconstruction with gracilis<br />
tendon graft sutured to the medial part of the patella with two anchors<br />
provides good postoperative patellar stability and seems equal to other<br />
surgical techniques in terms of patient satisfaction. Postoperative pain<br />
seems to be related to the degree of patellofemoral cartilage injury found<br />
at surgery.<br />
113