Letters to the Editor   |    
Patellar Complications Following Distal Femoral Replacement After Bone Tumor Resection
Dempsey S. Springfield, MD
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Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Feb 01;89(2):453-454
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To The Editor:In "Patellar Complications Following Distal Femoral Replacement After Bone Tumor Resection" (2006;88:2225-30), Schwab et al. draw our attention to an aspect of prosthetic reconstruction after a distal femoral resection that is important and often overlooked. They, correctly in my view, state, "the position of the joint line deserves special attention..." Unfortunately, I believe they do not appreciate the cause of their most common complication, which is elevation of the joint line. This causes so-called patella baja and patellar impingement. The authors reference an article by Thorpe et al. and suggest that some of their patients may have had fibrous bands as described in that study1. The patients in the study by Thorpe et al. did not have patella baja caused by fibrous bands, and they were cured with an arthroscopic release of the bands. Schwab et al. mention scarring of the patellar tendon that was possibly related to relative devascularization. The reference they cite describes only the vascularity of the patella, not of the patellar tendon, and actually notes that the vascular supply is abundant2. To support a theory that the patellar tendon shortens in the postoperative period, the authors should show serial lateral radiographs demonstrating this shortening.
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