To report on the use of the Ligament Advanced Reinforcement System (LARS) to enhance joint stability and functional outcome in proximal humeral endoprosthesis reconstruction.
Methods.
Two men and 5 women aged 16 to 66 (mean, 28) years underwent wide resection of tumour and endoprosthesis reconstruction of the proximal humerus using the LARS, as the rotator cuff and/or deltoid muscle could be preserved. The preserved muscles were reattached to anatomic positions to regain function. Shoulder range of motion and Musculoskeletal Tumour Society scores were evaluated.
Results.
The mean follow-up was 26 (range, 14–36) months. All the 7 patients were alive without disease. The mean active abduction was 77° (range, 60°–100°), and the mean active flexion was 74° (range, 50°–100°). The mean Musculoskeletal Tumour Society score was 86% (range, 80–93%). One patient had instability of the glenohumeral joint at one year.
Conclusion.
The LARS may enhance soft-tissue reattachment and improve shoulder stability after proximal humeral endoprosthetic reconstruction.
RuggieriPMavrogenisAFPalaEAbdel-Mota'alMMercuriM. Long term results of fixed-hinge megaprostheses in limb salvage for malignancy. Knee2012;19:543–9.
2.
CannonCPParaliticciGULinPPLewisVOYaskoAW. Functional outcome following endoprosthetic reconstruction of the proximal humerus. J Shoulder Elbow Surg2009;18:705–10.
3.
van de SandeMADijkstraPDTaminiauAH. Proximal humerus reconstruction after tumour resection: Biological versus endoprosthetic reconstruction. Int Orthop2011;35:1375–80.
4.
MarulandaGAHendersonECheongDLetsonGD. Proximal and total humerus reconstruction with the use of an aortograft mesh. Clin Orthop Relat Res2010;468:2896–903.
5.
HigueraCAInoueNLimJSZhangRDimaanoNFrassicaFJ. Tendon reattachment to a metallic implant using an allogenic bone plate augmented with rhOP-1 vs. autogenous cancellous bone and marrow in a canine model. J Orthop Res2005;23:1091–9.
6.
MachotkaZScarboroughIDuncanWKumarSPerratonL. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): A systematic review. Sports Med Arthrosc Rehabil Ther Technol2010;2:29.
7.
EnnekingWFDunhamWGebhardtMCMalawarMPritchardDJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res1993;286:241–6.
8.
HendersonERGroundlandJSPalaEDennisJAWootenRCheongD. Failure mode classification for tumor endoprostheses: Retrospective review of five institutions and a literature review. J Bone Joint Surg Am2011;93:418–29.
9.
ZeegenENAponte-TinaoLAHornicekFJGebhardtMCMankinHJ. Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res2004;420:239–50.
10.
BilginSS. Reconstruction of proximal humeral defects with shoulder arthrodesis using free vascularized fibular graft. J Bone Joint Surg Am2012;94:e94.
11.
KassabMDumaineVBabinetAOuaknineMTomenoBAnractP. Twenty nine shoulder reconstructions after resection of the proximal humerus for neoplasm with mean 7-year follow-up [in French]. Rev Chir Orthop Reparatrice Appar Mot2005;91:15–23.
12.
OnodaSSakurabaMAsanoTMiyamotoSBeppuYChumanH. Use of vascularized free fibular head grafts for upper limb oncologic reconstruction. Plast Reconstr Surg2011;127:1244–53.
13.
AbdeenAHoangBHAthanasianEAMorrisCDBolandPJHealeyJH. Allograft-prosthesis composite reconstruction of the proximal part of the humerus: Functional outcome and survivorship. J Bone Joint Surg Am2009;91:2406–15.
14.
AbdeenAHealeyJH. Allograft-prosthesis composite reconstruction of the proximal part of the humerus: Surgical technique. J Bone Joint Surg Am2010;92(Suppl 1):188–96.
15.
PotterBKAdamsSCPitcherJDJrMalininTITempleHT. Proximal humerus reconstructions for tumors. Clin Orthop Relat Res2009;467:1035–41.
16.
LiJWangZGuoZWuYChenGPeiG. Precise resection and biological reconstruction for patients with bone sarcomas in the proximal humerus. J Reconstr Microsurg2012;28:419–25.
17.
GoshegerGHillmannALindnerNRodlRHoffmannCBurgerH. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res2001;393:264–71.
18.
NathanSSGuerzonERBhavanamKTanLHZarchiKPereiraBP. Collagen membranes for host-implant integration: A pilot clinical study. J Orthop Surg (Hong Kong)2011;19:157–63.
19.
DominkusMSabetiMTomaCAbdolvahabFTriebKKotzRI. Reconstructing the extensor apparatus with a new polyester ligament. Clin Orthop Relat Res2006;453:328–34.
20.
NewmanSDAtkinsonHDWillis-OwenCA. Anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system: A systematic review. Int Orthop2013;37:321–6.
