INTRODUCTION

Patellar tendon (PT) autograft is an excellent choice repairing anterior cruciate ligament (ACL) ruptures. Published studies testing the biomechanical characteristics after plasty usually refer to grafts with 10mm wide. The thickness of PT and geometry of the patella have been overlooked.

The purpose of this study was to understand the geometry of PT and patella in our population, regarding their use in Bone - Patellar Tendon - Bone (BTB) technique, in order to evaluate their biomechanical efficiency and study their relationship with anthropometric parameters.

Introduction: Most of the bone metastases have origin in breast, lung, prostate, thyroid and kidney neoplasms. The commonest locations are the axial skeleton and the proximal region of the long bones, being the femur the most affected one. The main objectives of the surgical treatment are a quick functional recuperation and immediate pain relief.

Objectives: The aim of this work was to define a strategy for the surgical treatment of the bone methastasis located in the femur.

Material: The study includes 94 patients with femoral methastasis (100 metastasis) surgicaly treated in the last 10 years in our department.

Methods: Retrospective descriptive study based on medical records evaluation.

Results: The proximal third of the femur was involved in 80 % of the cases. Pathological fracture was identified in 72 cases and impending fracture in 28. Half of the primitive neoplasms was originated in the breast. It was identified as solitary metastatic lesion only in 33 % of the situations. The mean patient survival time was 9,2 months. They were treated with a cemented calcar-replacing prosthesis in 40 patients, 10 patients submited to conventional arthroplasty and 36 with intramedullary fixation (usually a cephalomedullary nail). The remainder 14 were treated with other surgical techniques.

Discussion: The surgery is indicated in case of painful lytic injury or unresponsive to radiotherapy, pathological or impending fracture. The surgical technique depends on the location and size of the lesion and if it is a solitary or multiple bone lesion, choosing between arthroplasties, of preference with long femoral stem, and intramedullary fixation. As we have performed a retrospective study, a functional rigorous evaluation was not possible.

Conclusion: The treatment of metastatic femoral disease is not performed with the intention of cure but to improve significantly the patient’s life quality. The proximal third of the femur is the most reached place. Breast cancer was responsible for around 50 % of the cases. In 50% of the patients the surgical option was an arthroplasty and techniques of femoral nailing were performed in 36%. The cemented replacement prosthesis is used in proximal large injuries with periarticular involvement: The intramedullary fixation is reserved for situations in which the femoral head and neck are not involved. The length of patient survival must exceed the predictable surgical recovery period.

Introduction: Soft tissue sarcomas (STS) are rare tumors. A multidisciplinary approach including surgery, chemotherapy and radiation therapy is recommended.

Materials and Methods: In the last 12 years, 249 patients with STS were teated in our Institution. All of them were treted with a multidisciplinary approach using all or some of the previous refered treatments.

Results: The overall local recurrence rate in the group of patients submited to surgery was 25% and this factor was related mostly with contaminated margins. Surgical resections were associted with soft tissue reconstructions when needed.

Radiation therapy was used in both regimens pre and post operativly, chemotherapy was also used in 85% of the patients, and was not dependent of tumor histotype.

23 patients were submited to surgery of lung metastasis.

Survival rates were determined and compared with stage (AJCC), tumor histotype and surgical margins.

Conclusions: Multidisciplinary approach is the recommended treatment for STS.