Characteristics, Patterns and Optimal Treatment Strategies of Morel-Lavallee Lesions: A Systematic Review.

Abstract

To evaluate the diagnostic accuracy of imaging modalities and outcomes of treatment strategies for Morel-Lavallée lesions (MLLs) and provide evidence-based recommendations for optimal management. Data Sources: MEDLINE, Embase, and Emcare databases were systematically searched for English-language studies published up to September 2024. Observational studies and randomized controlled trials (RCTs) reporting diagnostic accuracy or treatment outcomes for MLLs were included. Case reports, small series, animal studies, and non-English articles were excluded. Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) tool. Data on demographics, lesion characteristics, imaging modalities, and outcomes were extracted. Lesions were categorized as small (<100 cm3) or large (≥100 cm3) based on volume. Descriptive statistics summarized outcomes. Recurrence rates were calculated and pooled proportions compared across treatment modalities. Twenty-nine studies (928 patients, 964 lesions) were included. MLLs most frequently occurred in the thigh (26.5%), greater trochanter (24.9%), and lumbar region (20.3%). Among smaller lesions (<100 cm3), nonoperative treatment had a low recurrence rate (5.6%), while for larger lesions (>100 cm3), percutaneous management was associated with the highest recurrence rate (15%) compared to other treatment approaches. Operative treatment of large lesions had a 50% recurrence rate in one study, while sclerodesis achieved the lowest rate (4.8%) for lesions averaging 387 cm3, however, this finding is based on a limited number of cases (21 lesions). MRI was the most common single imaging modality reported (n=162 lesions, 19.5%), favoured for its superior soft-tissue characterization. Ultrasound was used in 121 lesions (14.6%) as an accessible initial assessment tool, while CT, often performed incidentally during trauma evaluation, diagnosed 339 lesions (40.9%). MRI was the most used single modality for diagnosing MLLs. Small, acute lesions were effectively managed nonoperatively. Large lesions (>100 cm3) often required operative management. Sclerodesis appears promising with the lowest recurrence (4.8%), but further studies are needed. Standardized treatment protocols may help improve outcomes and reduce recurrence. IV, systematic review.