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Published on: November 27, 2019
Masquelet technique: myth or reality? A systematic review and meta-analysis
Ilaria Morelli1, Lorenzo Drago2, David A George3
1Department of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit, I.R.C.C.S. Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy; Università degli Studi di Milano, via Festa del Perdono 7, 20122 Milano, Italy.
The induced membrane technique (IMT) or Masquelet technique, effectively treats bone defects and infections, achieving union in 89.7% of cases. However, 18% of patients required re-intervention due to persistent issues, highlighting the need for tailored surgical approaches.
Area of Science:
- Orthopedic Surgery
- Regenerative Medicine
- Biomaterials Science
Background:
- The induced membrane technique (IMT), also known as the Masquelet technique, is a two-stage surgical procedure for treating pseudoarthroses and bone defects.
- Numerous variations of the IMT have been developed by different surgical teams.
- This study systematically reviews these variants to assess their effectiveness in eradicating infection and promoting bone union.
Purpose of the Study:
- To compare the various surgical techniques within the induced membrane technique (IMT).
- To evaluate the efficacy of IMT in achieving bone union and eradicating infections in adult long bone defects.
- To identify factors influencing the success rates and complications of IMT.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searches of PubMed and other databases were performed using keywords 'Masquelet technique' and 'induced membrane technique'.
- Included studies were in English, French, or Italian, focused on adult long bone IMT with at least 5 cases and a 12-month follow-up. Statistical analysis included Fischer's exact test, chi-square, and unpaired t-tests.
Main Results:
- Seventeen papers (427 patients) met the criteria; 10 studies (137 cases) provided individual data.
- Overall bone union rate was 89.7%, and infection eradication was achieved in 91.1% of cases.
- Complications included superficial (4.9%) and deep infections (4.4%), with 18% experiencing persistent infection or non-union requiring re-intervention. Re-intervention correlated with poorer outcomes (p=0.005).
Conclusions:
- The induced membrane technique (IMT) shows high efficacy in bone union and infection eradication, but 18% of cases necessitate re-intervention.
- Surgical variants and patient-specific factors likely influence outcomes, suggesting a need for individualized treatment strategies.
- Further research is required to elucidate the impact of patient characteristics and IMT variants on treatment success.