Clinical Research Article Surgical Reconstruction of the Proximal Tibia in Primary Bone Tumors in Children and Adolescent Patients: A 30-Year Retrospective Study of Osteoarticular and Resurfaced Allografts

BACKGROUND: The proximal tibia is a common site for primary bone tumors in children and presents unique reconstructive challenges. Despite surgical advances, optimal strategies remain controversial, and complication rates are high. While several studies have compared reconstruction methods, few have specifically described the long-term evolution of biological reconstruction strategies for pediatric proximal tibial tumors. The main purpose of this study was to illustrate the development of biological reconstruction techniques for proximal tibial tumors in children and assess associated complications and allograft survival. METHODS: This retrospective study included 60 pediatric patients who underwent proximal tibial reconstruction with either osteoarticular (OA) or resurfaced osteoarticular (ROA) allografts between 1990 and 2021. OA procedures (n=14) represents the early phase of our experience, with surgeries performed between 1990 and 2000, whereas ROA procedures (n=46) reflect subsequent refinements, and were performed from 1996; differences in sample size, treatment period, and technique are inherent to the study's descriptive, observational design. Clinical outcomes, complication profiles, and allograft survival were analyzed with a minimum 2-year follow-up. RESULTS: Patient characteristics were comparable across groups. The use of ROA increased significantly over time ( P <0.001). Postoperative complications occurred in 34 patients (57%), with allograft fracture (44%) and pseudoarthrosis (32%) being the most frequent. Complication rates were associated with reconstruction type ( P =0.031). Allograft failure occurred in 82% of complicated cases. Allograft survival was 56% at 5 years and 48% at 10 years. ROA showed higher, though not statistically significant, survival compared with OA (58% vs. 19%, P =0.236). At final follow-up, 67% of patients were alive and disease-free. CONCLUSION: Biological reconstruction of pediatric proximal tibial tumors remains complex but offers acceptable long-term outcomes. This series illustrates a progressive e transition from OA to ROA techniques, associated with favorable allograft survival and reduced fracture rates. Despite high complication rates, many failures were managed without compromising future reconstructive options. Infection remains a critical concern, emphasizing the importance of surgical precision. LEVEL OF EVIDENCE: Level II-prognostic study.