Gradual loaded exercise of knee extension muscles using an orthosis after wide resection of a femoral sarcoma and quadriceps muscle: a case report.
Case report
Orthosis
Quadriceps muscle
Soft-tissue sarcoma
Wide resection
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
17 Oct 2023
17 Oct 2023
Historique:
received:
14
07
2021
accepted:
06
09
2023
medline:
23
10
2023
pubmed:
17
10
2023
entrez:
16
10
2023
Statut:
epublish
Résumé
Details of improved gait ability after wide resection of soft tissue sarcomas that necessitate removal of portions of the quadricep muscle have not yet been reported. We describe a patient with improved gait ability following a rehabilitation program after wide resection of a soft tissue sarcoma that included four components of the quadricep muscle. An 85-year-old Japanese man underwent wide resection of an undifferentiated pleomorphic sarcoma that included portions of the quadriceps femoris muscle. The rectus femoris, vastus medialis, sartorius, and vastus intermedius were separated in the maximally bulging region of the tumour. Three weeks postoperatively, gait exercise was initiated using a rigid knee orthosis with a dual-adjustable lock knee. The contraction loading of the knee extension muscle was controlled by adjusting the hinge motion range of the orthosis as follows: fully extended, fixed knee 0°-30°, and free range. Under this regimen, he could walk independently without a rigid orthosis within 5 weeks postoperatively but could not sit on his heels during daily living activities. At six months, there was no clinical evidence of recurrent tumours or complications. Postoperative gait ability might be affected by not only the number of resected muscles but also by the function of the separated muscles and the cross-sectional area of the remaining muscle. Gradually loaded exercise of the knee extension muscles using an orthosis could result in an improved gait motion for patients who undergo wide resection of a sarcoma that includes four components of the quadriceps femoris.
Sections du résumé
BACKGROUND
BACKGROUND
Details of improved gait ability after wide resection of soft tissue sarcomas that necessitate removal of portions of the quadricep muscle have not yet been reported. We describe a patient with improved gait ability following a rehabilitation program after wide resection of a soft tissue sarcoma that included four components of the quadricep muscle.
CASE PRESENTATION
METHODS
An 85-year-old Japanese man underwent wide resection of an undifferentiated pleomorphic sarcoma that included portions of the quadriceps femoris muscle. The rectus femoris, vastus medialis, sartorius, and vastus intermedius were separated in the maximally bulging region of the tumour. Three weeks postoperatively, gait exercise was initiated using a rigid knee orthosis with a dual-adjustable lock knee. The contraction loading of the knee extension muscle was controlled by adjusting the hinge motion range of the orthosis as follows: fully extended, fixed knee 0°-30°, and free range. Under this regimen, he could walk independently without a rigid orthosis within 5 weeks postoperatively but could not sit on his heels during daily living activities. At six months, there was no clinical evidence of recurrent tumours or complications.
CONCLUSIONS
CONCLUSIONS
Postoperative gait ability might be affected by not only the number of resected muscles but also by the function of the separated muscles and the cross-sectional area of the remaining muscle. Gradually loaded exercise of the knee extension muscles using an orthosis could result in an improved gait motion for patients who undergo wide resection of a sarcoma that includes four components of the quadriceps femoris.
Identifiants
pubmed: 37845768
doi: 10.1186/s13256-023-04165-9
pii: 10.1186/s13256-023-04165-9
pmc: PMC10580631
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
432Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Refaat Y, Gunnoe J, Hornicek FJ, Mankin HJ. Comparison of quality of life after amputation or limb salvage. Clin Orthop Relat Res. 2002;97:298–305.
doi: 10.1097/00003086-200204000-00034
Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer. 2004;91:1012–4.
doi: 10.1038/sj.bjc.6602104
pubmed: 15292924
pmcid: 2747710
Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal femur. J Bone Joint Surg. 1994;76A:649–56.
doi: 10.2106/00004623-199405000-00004
Enneking W. Thirty years of limb salvage. Chir Organi Mov. 2003;88:321–5.
pubmed: 15259546
Messerschmitt PJ, Garcia RM, Abdul-Karim FW, Greenfield EM, Getty PJ. Osteosarcoma. J Am Acad Orthop Surg. 2009;17:515–27.
doi: 10.5435/00124635-200908000-00005
pubmed: 19652033
Gilbert NF, Cannon CP, Lin PP, Lewis VO. Soft-tissue sarcoma. J Am Acad Orthop Surg. 2009;17:40–7.
doi: 10.5435/00124635-200901000-00006
pubmed: 19136426
DeVissar E, Pawels J, Doysen JE, Mulder T, Veth RP. Gait adaptations during walking under visual and cognitive constraints: a study of patients recovering from limb salvage surgery of the lower limb. Am J Phys Med Rehabil. 1998;77:503–9.
doi: 10.1097/00002060-199811000-00010
Shehadeh A, Dahleh ME, Salem A, Sarhan Y, Sultan I, Henshaw RM, et al. Standardization of rehabilitation after limb salvage surgery for sarcomas improves patients’ outcome. Hematol Oncol Stem Cell Ther. 2013;6:105–11.
doi: 10.1016/j.hemonc.2013.09.001
pubmed: 24161605
Lane JM, Christ GH, Khan SN, Backus SI. Rehabilitation for limb salvage patients-kinesiologic parameters and psychologic assessment-. Cancer. 2001;92:1013–9.
doi: 10.1002/1097-0142(20010815)92:4+<1013::AID-CNCR1414>3.0.CO;2-D
pubmed: 11519028
Siegel GW, Biermann JS, Chugh R, Jacobson JA, Lucas D, Feng M, et al. The multidisciplinary management of bone and soft tissue sarcoma: an essential organizational framework. J Multidiscip Healthc. 2015;8:109–15.
pubmed: 25733913
pmcid: 4340372
Benedetti MG, Catani F, Donati D, Simoncini L, Giannini S. Muscle performance about the knee joint in patients who had distal femoral replacement after resection of a bone tumor: an objective study with use of gait analysis. J Bone Joint Surg. 2000;82A:1619–25.
doi: 10.2106/00004623-200011000-00016
Henshaw RM, Bickels J, Malawer MM. Modular endoprosthetic reconstruction for lower extremity skeletal defects: oncologic and reconstructive indications. Semin Arthroplasty. 1999;10:180–7.
Gudas SA. Rehabilitation of pediatric and adult sarcomas. Rehabil Oncol. 2000;18:10–3.
doi: 10.1097/01893697-200018030-00010
Katrak P, O’Connor B, Woodgate I. Rehabilitation after total femur replacement: a report of 2 cases. Arch Phys Med Rehabil. 2003;84:1080–4.
doi: 10.1016/S0003-9993(03)00041-8
pubmed: 12881839
Lo SJ, Yeo M, Puhaindran M, Hsu CC, Wei FC. A reappraisal of functional reconstruction of extension of the knee following quadriceps resection or loss. J Bone Joint Surg Br. 2012;94B:1016–23.
doi: 10.1302/0301-620X.94B8.29033
Andrews CC, Siegel G, Smith S. Rehabilitation to improve the function and quality of life of soft tissue and bony sarcoma patients. Patient Relat Outcome Meas. 2019;10:417–25.
doi: 10.2147/PROM.S130183
pubmed: 32099494
pmcid: 6997412
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–6.
doi: 10.1097/00003086-199301000-00035
Yamaguchi T, Hirano T, Yoshida G, Iwasaki K. Limb function after wide resection of quadriceps muscle for soft tissue sarcomas. Orthop Trauma. 1996;45:917–21.
doi: 10.5035/nishiseisai.45.917
Houdek MT, Wagner ER, Wilke BK, Wyles CC, Taunton MJ, Sim FH. Long term outcomes of cemented endoprosthetic reconstruction for periarticular tumors of the distal femur. Knee. 2016;23:167–72.
doi: 10.1016/j.knee.2015.08.010
pubmed: 26362940
Reilly DT, Martens M. Experimental analysis of the quadriceps muscle force and patella-femoral joint reaction force for various activities. Acta Orthop Scand. 1972;43:126–37.
doi: 10.3109/17453677208991251
pubmed: 5079747