Joint-Sparing Resection around the Knee for Osteosarcoma: Long-Term Outcomes of Biologic Reconstruction with Vascularized Fibula Graft Combined with Massive Allograft

Simple Summary Osteosarcoma most frequently affects the metaphyseal region of the distal femur and proximal tibia; in around 20% of patients, the epiphyseal bone is not affected and an intercalary joint-sparing resection can be safely performed, preserving the native joint and ligament insertions. In young patients, according to their high functional expectations and potential long-life expectancy, the objective of reconstruction is to restore lower limb function with a low risk of reoperation and implant removal at long-term follow-up. VFG combined with massive allograft is one of the possible reconstructive options after intercalary resection around the knee. In the present study, we aimed to investigate the long-term results of this technique in patients treated for osteosarcoma around the knee with a joint-sparing resection.Abstract (1) Background: We aim to address the following questions. What was the complication rate of vascularized fibula graft (VFG) combined with massive allograft in patients treated with joint-sparing resection around the knee for a high-grade osteosarcoma? What was the long-term survivorship of VFG free from revision and graft removal? What were the functional results as assessed by the Musculoskeletal Tumor Society (MSTS) score? (2) Methods: 39 patients treated in our unit for osteosarcoma around the knee with intercalary resection and reconstruction with VFG combined with massive allograft were included; 26 patients underwent intercalary tibial resection, while 13 underwent intercalary femoral resection. (3) Results: Mean Follow-Up was 205 months (28 to 424). Complications that required surgery were assessed in requiring surgical revision in 19 patients (49%) after a mean of 31 months (0 to 107), while VFG removal was necessary in three patients (8%). The revision-free survival of the reconstructions was 59% at 5 years and 50% at 10 to 30 years. The overall survival of the reconstructions was 95% at 5 to 15 years and 89% at 20 to 30 years. The mean MSTS score was 29.3 (23 to 30). (4) Conclusions: VFG represents an effective reconstructive option after joint-sparing intercalary resection around the knee for osteosarcoma.