Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique

Gouron, Richard; Petit, Laurent; Boudot, Cédric; Six, Isabelle; Brazier, Michel; Kamel, Saı̈d; Mentaverri, Romuald

doi:10.1002/term.1921

Cited by 70 publications

(106 citation statements)

References 33 publications

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“…In comparison to our results, functional union was noted in six out of seven specimens. Another study used autologous bone graft harvested from the most caudal vertebral segments after amputation of the rat tail . Although clever, their approach is clearly not translational to humans.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have characterized the induced membrane formed by PMMA in rat models . There are clear similarities between human and rat induced membrane with respect to timing of membrane formation, histological composition including osteoprogenitor cells, and presence of important growth factors such as transforming growth factor‐beta (TGF‐β), bone morphogenetic protein‐2 (BMP‐2), and vascular endothelial growth factor (VEGF) .…”

Section: Discussionmentioning

confidence: 99%

“…Another study used autologous bone graft harvested from the most caudal vertebral segments after amputation of the rat tail. 35 Although clever, their approach is clearly not translational to humans. Interestingly, this study also does not specify the exact number or percentage of unions in the grafted induced membrane group.…”

Section: Discussionmentioning

confidence: 99%

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Preclinical induced membrane model to evaluate synthetic implants for healing critical bone defects without autograft

DeBaun

Stahl

Daoud

et al. 2018

Journal Orthopaedic Research

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Critical bone defects pose a formidable orthopaedic problem in patients with bone loss. We developed a preclinical model based on the induced membrane technique using a synthetic graft to replace autograft for healing critical bone defects. Additionally, we used a novel osteoconductive scaffold coupled with a synthetic membrane to evaluate the potential for single‐stage bone regeneration. Three experimental conditions were investigated in critical femoral defects in rats. Group A underwent a two‐stage procedure with insertion of a polymethylmethacrylate (PMMA) spacer followed by replacement with a 3D printed polycaprolactone(PCL)/β‐tricalcium phosphate (β‐TCP) osteoconductive scaffold after 4 weeks. Group B received a single‐stage PCL/β‐TCP scaffold wrapped in a PCL‐based microporous polymer film creating a synthetic membrane. Group C received a single‐stage bare PCL/β‐TCP scaffold. All groups were examined by serial radiographs for callus formation. After 12 weeks, the femurs were explanted and analyzed with micro‐CT and histology. Mean callus scores tended to be higher in Group A. Group A showed statistically significant greater bone formation on micro‐CT compared with other groups, although bone volume fraction was similar between groups. Histology results suggested extensive bone ingrowth and new bone formation within the macroporous scaffolds in all groups and cell infiltration into the microporous synthetic membrane. This study supports the use of a critical size femoral defect in rats as a suitable model for investigating modifications to the induced membrane technique without autograft harvest. Future investigations should focus on bioactive synthetic membranes coupled with growth factors for single‐stage bone healing. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Preclinical induced membrane model to evaluate synthetic implants for healing critical bone defects without autograft

DeBaun

Stahl

Daoud

et al. 2018

Journal Orthopaedic Research

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“…This is a timepoint shown previously to clearly result in union (or non-union) for this technique in rats. 20,39 …”

Section: Methodsmentioning

confidence: 99%

Masquelet Technique: Effects of Spacer Material and Micro-topography on Factor Expression and Bone Regeneration

et al. 2018

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We and others have shown that changing surface characteristics of the spacer implanted during the first Masquelet stage alters some aspects of membrane development. Previously we demonstrated that titanium spacers create membranes that are better barriers to movement of solutes >70kDa in size than polymethyl methacrylate (PMMA) induced-membranes, and roughening creates more mechanically compliant membranes. However, it is unclear if these alterations affect the membrane’s biochemical environment or bone regeneration during the second stage. Ten-week-old, male Sprague-Dawley rats underwent an initial surgery to create an externally stabilized 6mm femoral defect. PMMA or titanium spacers with smooth (~1um) or roughened (~8um) surfaces were implanted. Four weeks later, rats were either euthanized for membrane harvest or underwent the second Masquelet surgery. Titanium spacers induced thicker membranes that were similar in structure and biochemical expression. All membranes were bilayered with the inner layer having increased factor expression (BMP2, TGFβ, IL6, and VEGF). Roughening increased overall IL6 levels. Ten-weeks post-engraftment, PMMA-smooth induced membranes better supported bone regeneration (60% union). The other groups only had 1 or 2 that united (9–22%). There were no significant differences in any microCT or dynamic histology outcome. In conclusion, this study suggests that the membrane’s important function in the Masquelet technique is not simply as a barrier. There is likely a critical biochemical, cellular, or vascular component as well.

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“…[3][4][5] The presence of these factors has been demonstrated in both human and animal induced membranes over PMMA. 3,[5][6][7] Ultimately, this membrane serves as an endogenously derived depot of growth factors for the second stage of reconstruction, which involves the removal of the PMMA construct and definitive reconstruction with a graft or flap.…”

Section: Introductionmentioning

confidence: 99%

Effects of Local Antibiotic Delivery from Porous Space Maintainers on Infection Clearance and Induction of an Osteogenic Membrane in an Infected Bone Defect

Shah

Smith

Tatara

et al. 2017

Tissue Engineering Part A

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Reconstruction of large bone defects can be complicated by the presence of both infection and local antibiotic administration. This can be addressed through a two-stage reconstructive approach, called the Masquelet technique, that involves the generation of an induced osteogenic membrane over a temporary poly(methyl methacrylate) (PMMA) space maintainer, followed by definitive reconstruction after the induced membrane is formed. Given that infection and antibiotic delivery each have independent effects on local tissue response, the objective of this study is to evaluate the interaction between local clindamycin release and bacterial contamination with regards to infection prevention and the restoration of pro-osteogenic gene expression in the induced membrane. Porous PMMA space maintainers with or without clindamycin were implanted in an 8 mm rat femoral defect model with or without Staphylococcus aureus inoculation for 28 days in a full-factorial study design (four groups, n = 8/group). Culture results demonstrated that 8/8 animals in the inoculated/no antibiotic group were infected at 4 weeks, which was significantly reduced to 1/8 animals in the inoculated/antibiotic group. Quantitative polymerase chain reaction analysis demonstrated that clindamycin treatment restores inflammatory cytokine and growth factor expression to the same levels as the no inoculation/no antibiotic group, demonstrating that clindamycin can ameliorate the negative effects of bacterial inoculation and does not itself negatively impact the expression of important cytokines. Main effect analysis shows that bacterial inoculation and clindamycin treatment have independent and interacting effects on the gene expression profile of the induced membrane, further highlighting that antibiotics play an important role in the regeneration of infected defects apart from their antimicrobial properties.

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Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique

Cited by 70 publications

References 33 publications

Preclinical induced membrane model to evaluate synthetic implants for healing critical bone defects without autograft

Preclinical induced membrane model to evaluate synthetic implants for healing critical bone defects without autograft

Masquelet Technique: Effects of Spacer Material and Micro-topography on Factor Expression and Bone Regeneration

Effects of Local Antibiotic Delivery from Porous Space Maintainers on Infection Clearance and Induction of an Osteogenic Membrane in an Infected Bone Defect

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