La technique de la membrane induite « engainante » pour le traitement des pseudarthroses rebelles sans perte de substance osseuse et le renforcement des reconstructions osseuses segmentaires fragiles. Rapport préliminaire

Masquelet, A. C.; Gaillard, Julien; Boutroux, Pierre; Beauthier-Landauer, V.

doi:10.1016/j.anplas.2020.04.004

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…Within the limits of this animal model, we found it would be possible to replace PMMA spacers with polypropylene syringes without altering the properties of membrane formation or efficiency of bone repair. This finding is important because the availability of PMMA is a limiting factor for performing the Masquelet technique in settings where there are minimal resources [19,24,25].…”

Section: Discussionmentioning

confidence: 99%

“…2C). Saline irrigation protected the surrounding tissues from heat during polymerization [19]. Polypropylene spacers were made using a 1-mL syringe barrel (Omnifix-F Solo, B. Braun), split into two parts and stabilized above the bone defect with two sliding locking Nice knots using a Vicryl 5/0 resorbable suture (Ethicon) (Fig.…”

Section: Stage 1 Of the Masquelet Techniquementioning

confidence: 99%

“…The induced-membrane technique described by Masquelet [17] in 2000 is a widely accepted method for reconstructing large segmental bone defects [9,17,19,24,25]. It is performed as a two-stage procedure involving the placement of a cement spacer in the first stage and a large bone graft in the second stage.…”

Section: Introductionmentioning

confidence: 99%

“…It is performed as a two-stage procedure involving the placement of a cement spacer in the first stage and a large bone graft in the second stage. The spacer performs a mechanical action in which it prevents invasion of fibrous tissue in the recipient site and a biological action via the induction of a surrounding membrane resulting from a foreign-body reaction [17,19]. Within the first weeks of membrane formation, several angiogenic and osteogenic mediators are secreted, such as vascular endothelial growth factor or bone morphogenetic protein 2 (BMP-2) [16,29].…”

Section: Introductionmentioning

confidence: 99%

“…To date, the PMMA spacer remains the gold standard for foreign body encapsulation membrane induction in the reconstruction of critical bone defects [19]. As a result, we observed in our military and humanitarian practices that the absence of PMMA can preclude the use of Masquelet technique in developing countries [27].…”

Section: Introductionmentioning

confidence: 99%

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The Masquelet Technique: Can Disposable Polypropylene Syringes be an Alternative to Standard PMMA Spacers? A Rat Bone Defect Model

Mathieu

Murison

Rousiers

et al. 2021

Clin Orthop Relat Res

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Background Usually, the two-stage Masquelet induced-membrane technique for extremity reconstruction begins with a polymethylmethacrylate (PMMA) cement spacer–driven membrane, followed by an autologous cancellous bone graft implanted into the membrane cavity to promote healing of large bone defects. In exceptional cases, spacers made of polypropylene disposable syringes were successfully used instead of the usual PMMA spacers because of a PMMA cement shortage caused by a lack of resources. However, this approach lacks clinical evidence and requires experimental validation before being recommended as an alternative to the conventional technique. Questions/purposes To (1) develop and (2) validate a critical-sized femoral defect model in rats for two stages of the Masquelet technique and to (3) compare the biological and bone healing properties of polypropylene-induced membranes and PMMA-induced membranes in this model. Methods Fifty male Sprague Dawley rats aged 8 weeks old received a 6-mm femur defect, which was stabilized with an external fixator that was converted into an internal device. In the development phase, the defect was filled with PMMA in 16 rats to determine the most favorable timing for bone grafting. Two rats were excluded since they died of anesthetic complications. The other 14 were successively euthanized after 2 weeks (n = 3), 4 weeks (n = 4), 6 weeks (n = 4), and 8 weeks (n = 3) for induced membrane analyses. In the validation phase, 12 rats underwent both stages of the procedure using a PMMA spacer and were randomly assigned to two groups, whether the induced membrane was preserved or removed before grafting. To address our final objective, we implanted either polypropylene or PMMA spacers into the defect (Masquelet technique Stage 1; n = 11 rats per group) for the period established by the development phase. In each group, 6 of 11 rats were euthanized to compare the biological properties of polypropylene-induced membranes and PMMA-induced membranes using histological qualitative analysis, semiquantitative assessment of the bone morphogenic protein-2 content by immunostaining, and qualitative assessment of the mesenchymal stromal cell (MSC; CD31-, CD45-, CD90+, and CD73+ phenotypes) content by flow cytometry. Quantitative measurements from serum bone turnover markers were also performed. The five remaining rats of each group were used for Masquelet technique Stage 2, in which rat bone allografts were implanted in the induced membrane cavity after the polypropylene or PMMA spacers were removed. These rats recovered for 10 weeks before being euthanized for microCT quantitative measurements and bone histology qualitative assessment to evaluate and compare the extent of bone regeneration between groups. Results Induced membrane analyses together with serum bone turnover measurements indicated that a 4-week interval time between stages was the most favorable. Removal of the induced membrane before grafting led to almost constant early implant failures with poor bone formation. Four-week-old rats with polypropylene-triggered induced membranes displayed similar histologic organization as rats with PMMA-driven induced membranes, without any difference in the cell density of the extracellular matrix (4933 ± 916 cells per mm2 for polypropylene versus 4923 ± 1284 cells per mm2 for PMMA; p = 0.98). Induced membrane-derived MSCs were found in both groups with no difference (4 of 5 with polypropylene versus 3 of 3 with PMMA; p > 0.99). Induced membrane bone morphogenic protein-2 immunolabeling and serum bone turnover marker levels were comparable between the polypropylene and PMMA groups. MicroCT analysis found that bone regeneration in the polypropylene group seemed comparable with that in the PMMA group (29 ± 26 mm3 for polypropylene versus 24 ± 18 mm3 for PMMA; p > 0.99). Finally, qualitative histological assessment revealed a satisfactory endochondral ossification maturation in both groups. Conclusion Using a critical-sized femoral defect model in rats, we demonstrated that polypropylene spacers could induce membrane encapsulation with histologic characteristics and bone regenerative capacities that seem like those of PMMA spacers. Clinical Relevance In a same bone site, polymers with close physical properties seem to lead to similar foreign body reactions and induce encapsulating membranes with comparable bone healing properties. Polypropylene spacers made from disposable syringes could be a valuable alternative to PMMA. These results support the possibility of a cementless Masquelet technique in cases of PMMA shortage caused by a lack of resources.

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Section: Discussionmentioning

confidence: 99%

Section: Stage 1 Of the Masquelet Techniquementioning

confidence: 99%