Allograft reconstruction after resection of malignant tumors of the scapula.

The oncologic and functional outcomes of six patients who had scapular allograft reconstruction after scapulectomy for malignant tumors were reviewed. Five patients had Stage IIB and one patient had Stage IB tumors. Total scapulectomy was done in five patients, and partial scapulectomy (glenoid and neck) was done in one patient. Frozen glycerolized scapular allografts were implanted and fixed with plates and screws. The scapular muscles were reattached to the allograft. Tendon reconstruction to replace the excised muscles was done in two patients. The patients were followed up for an average of 3.8 years (range, 2-6 years). Cosmesis, elbow, and hand function were good in all patients. There were no infections, nonunions, or shoulder dislocations. One patient fractured the body of the allograft after a fall. One patient had local recurrence and had scapulectomy 5 years postoperatively. Two patients died 3 and 5 years postoperatively with lung metastases but with functioning grafts. The mean functional result using the Musculoskeletal Tumor Society functional score was 82 (range, 77-87). In this series, scapular allograft reconstruction restored cosmesis, shoulder stability, and function. Preservation or reconstruction of rotator cuff muscles is recommended.

A study of retrieved allografts used to replace anterior cruciate ligaments.

PURPOSE: The purpose of the study was the examination of retrieved whole anterior cruciate ligament (ACL) replacement grafts to determine the rate and the extent of cellular replacement and remodeling of the grafts. TYPE OF STUDY: Gross and histopathologic examination of specimens. METHODS: Nine specimens of ACL replacement allografts and 1 autograft were obtained at autopsy and surgical procedures. RESULTS: Examination of these specimens from 20 days to 10 years after transplantation revealed a pattern of revascularization similar to that reported in previous biopsy studies. However, examination of the entire allografts showed that, at 2 years after transplantation, the central portions of the grafts remained acellular and that complete attachment was not present, but was found in a 3.5-year post-transplantation specimen. CONCLUSIONS: Because attachment of the graft to bone tunnel walls required over 2 years, the tunnel remodeling may be explained on a mechanical basis. The remodeling of ACL replacement grafts is a gradual or slow process. Complete remodeling and cellular replacement of the entire graft may require 3 years or longer.

Histiocitoma fibroso maligno del hueso: comportamiento biológico y evolución clínica (un decenio de experiencia) / Malignant fibrous histiocytoma of bone: biological behavior and clinical course (a ten-year experience)

Las cifras de supervivencia del histiocitoma fibroso maligno del hueso (HFM) se basan en pequeñas series que incluyen casos con un período de seguimiento muy corto. Esto ha conducido a cifras de supervivencias divergentes y confusión entre los médicos, con relación al comportamiento biológico y el modo de terapia de este tumor. Todos los casos de HFM del hueso publicados en la literatura se revisaron y fueron analizados los 90 casos con más de 5 años de seguimiento. El período de supervivencia de 5 años resultó ser del 37,8%, que es significativamente más bajo que la cifra correspondiente a la mayoría de las metastásis aparecieron dentro de los dos años. Los descubrimientos sugieren que el HFM del hueso es un sarcoma con un gran potencial metastásico y que la quimioterapia efectiva puede mejorar la supervivencia a largo plazo