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Objective To explore the reconstruction of extensor apparatus in proximal tibial prosthetic replacement. Methods According to the number and type of contact surfaces, the reconstruction methods are divided into the following categories: ( 1 ) Single interface: patellar tendon-prosthesis; ( 2 ) Dual interface: according to the type of interfaces: patellar tendon-artificial material-prosthesis; patellar tendon-cancellous bone-prosthesis; patellar tendon-fibula-residual tibia. The difference in degree of active and passive knee extension, Musculoskeletal Tumor Society ( MSTS ) score and incidence of patellar tendon avulsion are used to evaluate the effects of reconstruction. Results The successful reconstruction of extensor apparatus depends on the effective fixation between the remaining patellar tendon and the prosthesis. The effective fixation is determined by the stable contact interface. The single interface ( patellar tendon-prosthesis ) can’t achieve the final healing. The interface between the patellar tendon and the autogenous bone or the artificial material can achieve effective healing, and the autogenous bone or the artificial material can be fixed with the prosthesis through the scar formation. The biological reconstruction and strengthening method are reliable, and the patellar tendon avulsion rarely occurs. However, the operation is complicated and difficult to be standardized, so the scope of application is limited. Conclusions There is no ideal solution for the reconstruction of extensor apparatus. Dual interface reconstruction may theoretically achieve effective healing between the 2 interfaces, and it can be used as an alternative for extensor apparatus reconstruction.