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

In 2000, Masquelet reported a long bone reconstruction technique using an induced membrane formed around a polymethylmethacrylate (PMMA) spacer placed in the defect with appropriate stabilization followed by secondary bone graft after PMMA removal. This reconstruction procedure allows rapid and safe bone reformation for septic, traumatic, neoplastic or congenital bone defects. A rat model of the Masquelet technique was developed to further characterize the biological activities of this induced membrane. Our model allows healing of a critical‐sized femoral defect (8 mm) by means of this procedure over a period of 18 weeks. Comparison of induced membranes obtained 3, 4, 5 and 6 weeks after PMMA insertion indicated that this tissue changes over time. Several mineralization spots and bone cells were observed in contact with the PMMA, when assessed by Alizarin Red, Von Kossa, Alkaline phosphatase and Tartrate‐resistant acid phosphatase staining of the membranes. CTR (calcitonin receptor)‐ and RANK (Receptor Activator of Nuclear factor Kappa B)‐ positive mononuclear cells were detected in the induced membrane, confirming the presence of osteoclasts in this tissue. These cells were observed in a thin, highly cellular layer in the induced membrane in contact with the PMMA. Together, these findings suggest that the membrane is able to promote osteointegration of autologous corticocancellous bone grafts during the Masquelet technique by creating local conditions that may be favourable to graft bone remodelling and osteointegration. Copyright © 2014 John Wiley & Sons, Ltd.

[1]  R. Gouron,et al.  Bone defect reconstruction in children using the induced membrane technique: a series of 14 cases. , 2013, Orthopaedics & traumatology, surgery & research : OTSR.

[2]  S. Pannier,et al.  Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: preliminary results of five cases , 2013, Journal of children's orthopaedics.

[3]  J. Sales de Gauzy,et al.  Induced-membrane femur reconstruction after resection of bone malignancies: three cases of massive graft resorption in children. , 2013, Orthopaedics & traumatology, surgery & research : OTSR.

[4]  R. Gouron,et al.  Reconstruction of Congenital Pseudarthrosis of the Clavicle with Use of the Masquelet Technique: A Case Report. , 2012, JBJS case connector.

[5]  F. Chotel,et al.  Induced membrane technique for reconstruction after bone tumor resection in children: a preliminary study. , 2012, Orthopaedics & traumatology, surgery & research : OTSR.

[6]  J. Sales de Gauzy,et al.  Intercalary Segmental Reconstruction of Long Bones After Malignant Bone Tumor Resection Using Primary Methyl Methacrylate Cement Spacer Interposition and Secondary Bone Grafting: The Induced Membrane Technique , 2011, Journal of pediatric orthopedics.

[7]  Jeffrey C. Wang,et al.  Enhancement of recombinant human BMP‐7 bone formation with bmp binding peptide in a rodent femoral defect model , 2011, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[8]  C. Ursu,et al.  Early resection of congenital pseudarthrosis of the tibia and successful reconstruction using the Masquelet technique. , 2011, The Journal of bone and joint surgery. British volume.

[9]  K. Malizos,et al.  Vascularized fibula transfer for lower limb reconstruction , 2011, Microsurgery.

[10]  A. Uzel,et al.  Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane. , 2010, Orthopaedics & traumatology, surgery & research : OTSR.

[11]  H. Petite,et al.  Use of the induced membrane technique for bone tissue engineering purposes: animal studies. , 2010, The Orthopedic clinics of North America.

[12]  A. Masquelet,et al.  The concept of induced membrane for reconstruction of long bone defects. , 2010, The Orthopedic clinics of North America.

[13]  S. Catros,et al.  Mandibular reconstruction using induced membranes with autologous cancellous bone graft and HA-betaTCP: animal model study and preliminary results in patients. , 2009, International journal of oral and maxillofacial surgery.

[14]  Zhenxing Si,et al.  Successful repair of a critical-sized bone defect in the rat femur with a newly developed external fixator. , 2009, The Tohoku journal of experimental medicine.

[15]  D. Biau,et al.  Case Report: Reconstruction of a 16-cm Diaphyseal Defect after Ewing’s Resection in a Child , 2009, Clinical orthopaedics and related research.

[16]  A. Shin,et al.  Free vascularized fibula grafts for salvage of failed oncologic long bone reconstruction and pathologic fractures , 2009, Microsurgery.

[17]  Hermann Seitz,et al.  Validation of a femoral critical size defect model for orthotopic evaluation of bone healing: a biomechanical, veterinary and trauma surgical perspective. , 2008, Tissue engineering. Part C, Methods.

[18]  M. Manfrini,et al.  The Use of Free Vascularized Fibular Grafts in Skeletal Reconstruction for Bone Tumors in Children , 2007, The Journal of the American Academy of Orthopaedic Surgeons.

[19]  David J Mooney,et al.  Quantitative assessment of scaffold and growth factor‐mediated repair of critically sized bone defects , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[20]  W. Pederson,et al.  Long bone reconstruction with vascularized bone grafts. , 2007, The Orthopedic clinics of North America.

[21]  V. Bousson,et al.  Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: an ovine model. , 2006, Veterinary surgery : VS.

[22]  H. Zreiqat,et al.  Regulation of osteoclast activity in peri-implant tissues. , 2004, Biomaterials.

[23]  A C Masquelet,et al.  Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[24]  D. Oakes,et al.  An Evaluation of Human Demineralized Bone Matrices in a Rat Femoral Defect Model , 2003, Clinical orthopaedics and related research.

[25]  D. Howie,et al.  The osteoclastogenic molecules RANKL and RANK are associated with periprosthetic osteolysis. , 2001, The Journal of bone and joint surgery. British volume.

[26]  F. Fitoussi,et al.  [Reconstruction of the long bones by the induced membrane and spongy autograft]. , 2000, Annales de chirurgie plastique et esthetique.

[27]  D. Paley,et al.  Ilizarov bone transport treatment for tibial defects. , 2000, Journal of orthopaedic trauma.

[28]  N. Athanasou,et al.  Cytokine receptor profile of arthroplasty macrophages, foreign body giant cells and mature osteoclasts. , 1999, Acta orthopaedica Scandinavica.

[29]  J Aronson,et al.  Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. , 1997, The Journal of bone and joint surgery. American volume.

[30]  A. Simpson,et al.  OSTEOCLASTS ARE CAPABLE OF PARTICLE PHAGOCYTOSIS AND BONE RESORPTION , 1997, The Journal of pathology.

[31]  M A Freeman,et al.  Bone formation and bone resorption in failed total joint arthroplasties: Histomorphometric analysis with histochemical and immunohistochemical technique , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[32]  W H Harris,et al.  Formation of a synovial-like membrane at the bone-cement interface. Its role in bone resorption and implant loosening after total hip replacement. , 1986, Arthritis and rheumatism.

[33]  W H Harris,et al.  The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis. , 1983, The Journal of bone and joint surgery. American volume.