{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T01:43:41Z","timestamp":1785894221573,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,12,19]],"date-time":"2017-12-19T00:00:00Z","timestamp":1513641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,12,19]],"date-time":"2017-12-19T00:00:00Z","timestamp":1513641600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2017,12,19]],"date-time":"2017-12-19T00:00:00Z","timestamp":1513641600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","arthroscopyjournal.org","clinicalkey.fr","clinicalkey.com.au","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      To examine the histologic properties of supercritical carbon dioxide (sCO\n                      <jats:sub>2<\/jats:sub>\n                      )\u2013sterilized bone allograft for tunnel grafting and determine in\u00a0vivo graft quality, as well as graft incorporation and remodeling, in 2\u2010stage revision anterior cruciate ligament (ACL) surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Histologic evaluation was performed in 12 subjects undergoing 2\u2010stage revision ACL reconstruction. In the first stage, the femoral and tibial tunnels were debrided, tunnel dimensions were measured, and tunnels were grafted with sCO\n                      <jats:sub>2<\/jats:sub>\n                      \u2010sterilized bone allograft. In the second stage, revision ACL reconstruction was performed and bone biopsy specimens were taken from the tibia. Tissue, bone, and graft volumes were measured, and histomorphometric analysis was performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean time between the 2 stages was 8.8\u00a0months (range, 5.6\u201021.3\u00a0months). In the second stage, bone graft material was easily identified by its necrotic appearance comprising mature lamellar bone devoid of osteocyte nuclei within osteocyte lacunae. In all tissue samples, host\u2010bone apposition of predominantly mature lamellar bone was noted on the surface of graft fragments in keeping with \u201ccreeping substitution.\u201d In several regions in 3 cases, osteoblastic and osteoclastic activity was evident in keeping with ongoing creeping substitution and remodeling. The mean bone volume over tissue volume was 68% (range, 33%\u201092%), and the mean graft volume over bone volume was 41% (range, 19%\u201070%). The mean graft volume (8 cases) harvested at less than 7\u00a0months (44%; 95% confidence interval, 31.4%\u201056.8%) was not significantly different than the mean graft volume (4 cases) harvested at greater than 10\u00a0months (34%; 95% confidence interval, 14.3%\u201054.2%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .214).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The sCO\n                      <jats:sub>2<\/jats:sub>\n                      \u2010sterilized bone allograft showed graft incorporation and remodeling through creeping substitution.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>The initial bone apposition and graft fragment bridging appear to provide a strong environment for ACL graft fixation resulting in technically successful 2\u2010stage revision ACL reconstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2017.08.311","type":"journal-article","created":{"date-parts":[[2017,12,19]],"date-time":"2017-12-19T09:03:32Z","timestamp":1513674212000},"page":"706-713","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":19,"title":["Supercritical Carbon Dioxide\u2013Sterilized Bone Allograft in the Treatment of Tunnel Defects in 2\u2010Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic Evaluation"],"prefix":"10.1002","volume":"34","author":[{"given":"Gerrit J.","family":"Van de Pol","sequence":"first","affiliation":[{"name":"North Sydney Orthopaedic and Sports Medicine Centre Wollstonecraft 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