Outcomes and Challenges of Allograft Reconstruction for Distal Tibial Tumors: A Retrospective Case Series

Background Reconstruction of distal tibial tumours remains technically challenging due to limited soft tissue coverage, complex ankle biomechanics, and the need to achieve oncological clearance while preserving limb function. Although allograft reconstruction represents a biological limb salvage option, evidence regarding its outcomes in distal tibial reconstruction remains limited. This study aimed to evaluate graft union, complications, graft survival, oncological outcomes, and functional outcomes following tibial allograft reconstruction. Methods A retrospective observational study was performed at a tertiary orthopaedic oncology centre, reviewing patients who underwent tibial allograft reconstruction between 2016 and 2024. Six patients with distal or diaphyseal tibial tumours were included. Outcomes assessed included graft union, complications, graft survival, oncological outcomes, and functional outcomes measured using the Musculoskeletal Tumor Society (MSTS) score. Results Mean time to union was 19 months (range: 9-24 months). Five patients developed complications, including deep infection in three, non-union in one, and allograft fracture in one. Four patients required revision surgery. At final follow-up, three of six grafts remained intact. Mean MSTS score was 63.9% (range: 33.3%-96.7%). No local recurrence was observed. Conclusion Allograft reconstruction for distal tibial tumours may be considered a limb salvage option in carefully selected patients; however, it is associated with substantial complication and revision rates. Careful patient selection and continued refinement of reconstructive strategies are essential to improve outcomes while preserving limb function.