The Masquelet technique for membrane induction and the healing of ovine critical sized segmental defects

• Published in: PloS one Vol. 9; no. 12; p. e114122
• Main Authors: Christou, Chris, Oliver, Rema A, Yu, Yan, Walsh, William R
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02-12-2014; Public Library of Science (PLoS)
• Subjects: Animals; Biology and Life Sciences; Bone and Bones - metabolism; Bone and Bones - pathology; Bone growth; Bone morphogenetic protein 2; Bone Morphogenetic Protein 2 - metabolism; Bone Substitutes; Defects; Grafting; Growth factors; Healing; Innovations; Interleukin 6; Interleukin 8; Medicine and Health Sciences; Methods; Polymethyl Methacrylate; Polymethylmethacrylate; Research and Analysis Methods; Sheep; Transforming Growth Factor beta - metabolism; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - metabolism; Von Willebrand factor; Wound Healing
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0114122

The healing of critical sized segmental defects is an ongoing clinical problem. No method has achieved pre-eminence. The Masquelet technique is a relatively new innovation involving the induction of a fibrous tissue membrane around the bone defect site taking advantage of the body's foreign body reaction to the presence of a polymethylmethacrylate (PMMA) spacer. The aim of this study was to investigate the properties and characteristics of this induced membrane and its effectiveness when used in conjunction with allograft or an allograft/autograft mix as filler materials in an ovine critical sized defect model. The resultant induced membrane was found to be effective in containing the graft materials in situ. It was demonstrated to be an organised pseudosynovial membrane which expressed bone morphogenic protein 2 (BMP2), transforming growth factor-beta (TGFβ), vascular endothelial growth factor (VEGF), von Willerbrand factor (vWF), interleukin 6 (IL-6) and interleukin 8 (IL-8). While more new bone growth was evident in the test groups compared to the controls animals at 12 weeks, the volumes were not statistically different and no defects were fully bridged. Of the two graft material groups, the allograft/autograft mix was shown to have a more rapid graft resorption rate than the allograft only group. While the Masquelet technique proved effective in producing a membrane to enclose graft materials, its ability to assist in the healing of critical sized segmental defects when compared to empty controls remained inconclusive.