Supercritical Carbon Dioxide–Sterilized Bone Allograft in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic Evaluation

Pol, G.J. van de; Bonar, Fiona; Salmon, Lucy J.; Roe, Justin; Pinczewski, Leo A.

doi:10.1016/j.arthro.2017.08.311

Cited by 16 publications

(33 citation statements)

References 28 publications

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“…Preoperative tunnel size was reported in 5 studies (Table 3). 17,34-37 Measurements were taken intraoperatively with probing instruments in 2 studies, 17,36 whereas the authors of the other 3 studies based their measurements on preoperative imaging studies. 34,35,37 Of note, 2 of these studies 34,37 used the method described by L’Insalata et al 24 to obtain these measurements.…”

Section: Resultsmentioning

confidence: 99%

Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation

et al. 2019

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Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. Study design: Systematic review. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. PubMed, EMBASE, and the Cochrane Library were queried through use of the terms anterior cruciate ligament and revision to identify all studies reporting outcomes of bone tunnel grafting in 2-stage revision ACL reconstruction. Data extracted included indications for 2-stage surgery, surgical technique, graft material, time between surgeries, rehabilitation protocols, physical examination findings, patient-reported outcomes, and radiographic and histologic findings. Results: The analysis included 7 studies with a total of 234 patients. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean ± SD of 4.2 ± 2.1 years. The indication for bone grafting and between-stage protocol varied among studies. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). Finally, 1 study compared ICBG to a synthetic bone substitute. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. In 4 studies, the authors reported the time interval between first and second surgeries, with an average of 6.1 months for ICBG compared with 8.7 months for allogenic and synthetic grafts. Revision ACL graft failure rates were reported by 5 studies, including 1 study with ABM (6.1%), 1 study with AC (8.3%), 1 study with TBA (0%), and 2 studies with ICBG (0% and 2%). Conclusion: The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. The available data indicate that autograft for bone tunnel grafting in 2-stage ACL revision may be associated with a lower risk of revision ACL reconstruction graft failure compared with allograft bone.

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Section: Resultsmentioning

confidence: 99%

Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation

et al. 2019

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“…Recently, a technique for sterilizing musculoskeletal allografts using supercritical carbon dioxide (sCO2) has been developed [26]. In theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels.…”

Section: Bone Graftingmentioning

confidence: 99%

“…In theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels. The metaphyseal location and predominantly cancellous bone surrounding the graft tissue result in high osteoinductive and osteogenic potential from the host's bone marrow [26]. Van de pol et al [26] reported the use of a sCO2-sterilized bone allograft to fill tunnel defects as the first stage of a two-stage revision ACLR.…”

Section: Bone Graftingmentioning

confidence: 99%

“…The metaphyseal location and predominantly cancellous bone surrounding the graft tissue result in high osteoinductive and osteogenic potential from the host's bone marrow [26]. Van de pol et al [26] reported the use of a sCO2-sterilized bone allograft to fill tunnel defects as the first stage of a two-stage revision ACLR. The mean time between the two stages was 8.8 months and in the second stage, bone-biopsy specimens were taken from the tibia.…”

Section: Bone Graftingmentioning

confidence: 99%

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Two-stage revision anterior cruciate ligament reconstruction

Kim

Bae

Kim

et al. 2019

Knee Surg & Relat Res

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With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Among these potential scenarios requiring a two-stage revision, tunnel-widening is the most common cause; the first stage involves graft removal, tunnel curettage, and bone grafting, followed by revision ACL reconstruction in the second stage. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results.

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“…Along with the decellularization, scCO 2 is considered as a promising sterilizing agent for medical devices [ 33 , 34 , 35 , 36 ]. The combination of such stages as decellularization and sterilization in one environmentally friendly technological process can significantly reduce energy costs and increase economic efficiency in the production of transplants.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Supercritical CO2-Assisted Protocols in a Model of Ovine Aortic Root Decellularization

et al. 2020

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One of the leading trends in the modern tissue engineering is the development of new effective methods of decellularization aimed at the removal of cellular components from a donor tissue, reducing its immunogenicity and the risk of rejection. Supercritical CO2 (scCO2)-assisted processing has been proposed to improve the outcome of decellularization, reduce contamination and time costs. The resulting products can serve as personalized tools for tissue-engineering therapy of various somatic pathologies. However, the decellularization of heterogeneous 3D structures, such as the aortic root, requires optimization of the parameters, including preconditioning medium composition, the type of co-solvent, values of pressure and temperature inside the scCO2 reactor, etc. In our work, using an ovine aortic root model, we performed a comparative analysis of the effectiveness of decellularization approaches based on various combinations of these parameters. The protocols were based on the combinations of treatments in alkaline, ethanol or detergent solutions with scCO2-assisted processing at different modes. Histological analysis demonstrated favorable effects of the preconditioning in a detergent solution. Following processing in scCO2 medium provided a high decellularization degree, reduced cytotoxicity, and increased ultimate tensile strength and Young’s modulus of the aortic valve leaflets, while the integrity of the extracellular matrix was preserved.

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Supercritical Carbon Dioxide–Sterilized Bone Allograft in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic Evaluation

Cited by 16 publications

References 28 publications

Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation

Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation

Two-stage revision anterior cruciate ligament reconstruction

Evaluation of Supercritical CO2-Assisted Protocols in a Model of Ovine Aortic Root Decellularization

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