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Article ; Online: Second Extensor Compartment Entrapment in an Adult Following Distal Radius Fracture.

Beenfeldt, Davison M / Delman, Connor M / Bayne, Christopher O

Journal of hand surgery global online

2024 Volume 6, Issue 1, Page(s) 137–139

Abstract: Extensor tendon entrapment in the presence of distal radius fracture is a known but relatively uncommon complication. Single tendon or entire compartment entrapment has been described through the literature in youths and adults. However these findings ... ...

Abstract	Extensor tendon entrapment in the presence of distal radius fracture is a known but relatively uncommon complication. Single tendon or entire compartment entrapment has been described through the literature in youths and adults. However these findings generally are limited to a certain age demographic or are found on advanced imaging but are unable to be confirmed intraoperatively. We describe to our knowledge the first known description of second extensor compartment entrapment in an adult seen on computerized tomography scan and confirmed intraoperatively.
Language	English
Publishing date	2024-01-17
Publishing country	United States
Document type	Case Reports
ISSN	2589-5141
ISSN (online)	2589-5141
DOI	10.1016/j.jhsg.2023.10.002
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Article ; Online: Tantalum Cementless Versus Cemented Total Knee Arthroplasty: A Meta-analysis of Level 1 Studies.

Peddada, Kranti V / Delman, Connor M / Holland, Christopher T / Meehan, John P / Lum, Zachary C

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

2023 Volume 7, Issue 4

Abstract: Introduction: Controversy exists on the ideal type of fixation in total knee arthroplasty (TKA). Noncemented fixation has been theorized to improve patient outcomes and longevity of implantation without increased risk of aseptic loosening or radiolucent ...

Abstract	Introduction: Controversy exists on the ideal type of fixation in total knee arthroplasty (TKA). Noncemented fixation has been theorized to improve patient outcomes and longevity of implantation without increased risk of aseptic loosening or radiolucent lines. We sought to compare (1) patient-reported outcomes, (2) survivorship, and (3) revision rates for all-cause and aseptic loosening in a noncemented tantalum total knee with its cemented counterpart. Methods: Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were searched using a combination of keywords "trabecular metal," "tantalum knee," "total knee arthroplasty," and "cementless trabecular." Patient demographics such as age, sex, and body mass index were collected. Outcomes such as Knee Society Scores (KSSs), revisions, and radiolucent lines were recorded for analysis. Results: Four randomized controlled trials involving 507 patients with an average 5-year follow-up were eligible for meta-analysis. No differences were observed in any demographics such as age, sex, body mass index, nor preoperative KSS. Patients in the cemented cohort improved from preoperative KSS 46.4 to postoperative KSS 90.4 while the tantalum cohort improved from 46.4 to 89.3. No statistical difference was observed in postoperative KSS mean difference between groups. Six patients from the tantalum group underwent revision with one patient for aseptic loosening. Twelve patients from the cemented group underwent revision with four patients for aseptic loosening. No statistical difference was observed between rates of revision, aseptic loosening, or radiolucent line development. Discussion: Patient-reported outcomes improved postoperatively in both groups. No differences were detected between the cemented and noncemented TKAs in patient-reported outcomes, revision rates, or radiolucent line development. Noncemented tantalum fixation seems equivalent to cemented TKA survivorship. Longer term follow-up of these randomized controlled trials may provide a clearer understanding whether a difference exists.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee ; Tantalum ; Knee Prosthesis ; Reoperation ; Bone Cements/therapeutic use
Chemical Substances	Tantalum (6424HBN274) ; Bone Cements
Language	English
Publishing date	2023-04-07
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ZDB-ID	2898328-2
ISSN	2474-7661 ; 1067-151X
ISSN (online)	2474-7661
ISSN	1067-151X
DOI	10.5435/JAAOSGlobal-D-22-00219
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Article ; Online: Treatment of Dysplasia Epiphysealis Hemimelica with Autologous Chondrocyte Implantation: A Case Report.

Bacon, Adam / Delman, Connor M / Reynolds, James Phillip / Haus, Brian

JBJS case connector

2022 Volume 12, Issue 2, Page(s) 1–6

Abstract: Case: We present a case of dysplasia epiphysealis hemimelica (DEH) involving the posteromedial distal femur in a 4-year-old girl. The patient underwent lesion resection with internal fixation of the articular cartilage followed by autologous chondrocyte ...

Abstract	Case: We present a case of dysplasia epiphysealis hemimelica (DEH) involving the posteromedial distal femur in a 4-year-old girl. The patient underwent lesion resection with internal fixation of the articular cartilage followed by autologous chondrocyte implantation (ACI) to restore the articular surface and epiphysis. At the 7-year follow-up, the patient had no pain or difficulty with participation in sports. Advanced imaging showed a stable articular surface with evidence of durable cartilage integration. Conclusion: DEH is a rare disease often treated by resection. In cases where the articular surface of the knee is involved, we have demonstrated that augmentation with ACI can be an effective treatment option.
MeSH term(s)	Bone Diseases, Developmental/diagnostic imaging ; Bone Diseases, Developmental/pathology ; Bone Diseases, Developmental/surgery ; Cartilage, Articular/surgery ; Child, Preschool ; Chondrocytes ; Female ; Femur/abnormalities ; Femur/pathology ; Femur/surgery ; Humans ; Tibia/abnormalities
Language	English
Publishing date	2022-10-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	e21.00668
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Article ; Online: Editorial Commentary: Drill and Fill: Bone Marrow Stimulation Plus Allograft Matrix May Optimize the Treatment of Osteochondral Lesions of the Talus.

Delman, Connor M / Kreulen, Christopher / Giza, Eric

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2021 Volume 37, Issue 7, Page(s) 2270–2271

Abstract: Osteochondral lesions of the talus remain a challenging pathologic entity facing orthopaedic foot and ankle surgeons. Although multiple treatment options exist, there is limited evidence supporting one technique over another. The ultimate goal of ... ...

Abstract	Osteochondral lesions of the talus remain a challenging pathologic entity facing orthopaedic foot and ankle surgeons. Although multiple treatment options exist, there is limited evidence supporting one technique over another. The ultimate goal of surgical intervention is to achieve lesion infill with tissue properties that best mimic those of hyaline articular cartilage. Restoring the anatomic surface of the talus may provide long-term clinical success and improve function. Augmentation of bone marrow stimulation with extracellular matrix cartilage allograft aims to achieve this goal.
MeSH term(s)	Allografts ; Bone Marrow ; Bone Transplantation ; Cartilage, Articular/surgery ; Humans ; Talus/surgery
Language	English
Publishing date	2021-06-05
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2021.04.046
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Zs.A 2046: Show issues

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Article ; Online: The posterolateral upslope of a low-conforming insert blocks the medial pivot during a deep knee bend in TKA: a comparative analysis of two implants with different insert conformities.

Delman, Connor M / Ridenour, Delaney / Howell, Stephen M / Hull, Maury L

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA

2021 Volume 31, Issue 9, Page(s) 3627–3636

Abstract: Purpose: Tibial insert conformity in total knee arthroplasty (TKA) is of interest due to the potential effect on tibiofemoral kinematics. This study determined differences in anterior-posterior movements of the femoral condyles, pivot locations, and ... ...

Abstract	Purpose: Tibial insert conformity in total knee arthroplasty (TKA) is of interest due to the potential effect on tibiofemoral kinematics. This study determined differences in anterior-posterior movements of the femoral condyles, pivot locations, and internal tibial rotation in different arcs of flexion for two implants with different insert conformities in kinematically aligned TKA. Methods: Twenty-five patients treated with a medial and lateral low-conforming, posterior cruciate ligament (PCL) retaining (LC CR) implant followed by a medial ball-in-socket and flat, lateral PCL sacrificing (B-in-S CS) implant in the contralateral knee underwent single-plane fluoroscopy during a deep knee bend. Analysis following 3D-to-2D image registration determined tibiofemoral kinematics and patients completed validated outcome scores for both knees. Results: The mean follow-up of 1.6 ± 0.4 years for the knee with the B-in-S CS implant was shorter than the 2.7 ± 1.2 years for the LC CR implant. From 0º to 30º of flexion, a medial pivot occurred with the tibia rotating internally approximately 5º with both implants. From 30º to 90º, the pivot remained medial and internal rotation increased to 10º with the B-in-S CS implant. In contrast, neither femoral condyle moved more than 1 mm with the LC CR implant from 30º to 60º, but from 60º to 90º degrees, a lateral pivot occurred and internal rotation increased. Internal rotation of the tibia on the femur from 0° to maximum flexion occurred about a medial pivot similar to the native knee for the B-in-S CS implant and was 4.5° greater than that of the LC CR implant (10.4° vs 5.9°). There was no difference in the median patient-reported outcome scores between implant designs. Conclusions: Tibial insert conformity is a primary determinant of a medial or lateral pivot during a deep knee bend. One explanation for the transition from a medial to lateral pivot between 30º and 60º with the LC CR implant is the chock-block effect of the insert's posterolateral upslope which impedes posterior movement of the lateral femoral condyle. Because there is no posterolateral upslope in the insert of the B-in-S CS implant, the tibia pivots medially throughout flexion similar to the native knee. Level of evidence: Level III.
MeSH term(s)	Knee/surgery ; Exercise ; Arthroplasty, Replacement, Knee ; Knee Prosthesis ; Femur ; Range of Motion, Articular ; Tibia ; Humans ; Male ; Female ; Middle Aged ; Aged ; Aged, 80 and over
Language	English
Publishing date	2021-08-04
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	1159064-6
ISSN	1433-7347 ; 0942-2056
ISSN (online)	1433-7347
ISSN	0942-2056
DOI	10.1007/s00167-021-06668-8
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Article ; Online: Survivorship and Etiologies of Failure in Single-stage Revision Arthroplasty for Periprosthetic Joint Infection: A Meta-analysis.

Peddada, Kranti V / Welcome, Brandon M / Parker, Mitchell C / Delman, Connor M / Holland, Christopher T / Giordani, Mauro / Meehan, John P / Lum, Zachary C

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

2023 Volume 7, Issue 5

Abstract: Introduction: Single-stage revision arthroplasty for periprosthetic joint infection (PJI) may yield comparable infection-free survivorship with two-stage revision arthroplasty. It is unclear if the most common mode of failure of single-stage revision ... ...

Abstract	Introduction: Single-stage revision arthroplasty for periprosthetic joint infection (PJI) may yield comparable infection-free survivorship with two-stage revision arthroplasty. It is unclear if the most common mode of failure of single-stage revision arthroplasty is infection or aseptic loosening. In this meta-analysis, we sought to (1) determine survivorship and (2) compare rates of different etiologies of failure of single-stage revision total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: Preferred Reporting Items for Systematic Review and Meta-analyses guidelines search was done using search terms for "single stage revision," "exchange arthroplasty," "periprosthetic infection," "PJI," and "single stage." Patient demographics such as age, body mass index, and mean follow-up time were recorded. Overall survivorship and rates of revision surgery were aggregated using a random-effects model. Comparison of septic and aseptic loosening rates was done by risk difference and associated 95% confidence interval (CI) calculation. Results: Twenty-four studies were identified with 2,062 and 147 single-stage revision THA and TKA procedures performed between 1984 and 2019, respectively. The weighted mean follow-up and age were 69.8 months and 66.3 years, respectively, with 55% men overall. The all-cause revision surgery rate was 11.1% and 11.8% for THA and TKA, respectively. The revision surgery rate secondary to infection and aseptic loosening and associated 95% CI for the risk difference for THA and TKA was 5.5% and 3.3% (-1.7% to 5.0%), and 3% and 8.8% (-11.4% to 2.3%), respectively. Revision surgeries due to instability and fracture combined and mortality rate were both less than 3%. Discussion: Single-stage revision THA and TKA for PJI demonstrated overall high rates of survivorship, low mortality, and revision surgeries secondary to infection and aseptic loosening to be equivalent. Aseptic loosening after single-stage revision TKA might be higher than in primary TKA. As implant survivorship from infection improves in PJI, surgeons should be aware of aseptic loosening as an equally common mode of failure.
MeSH term(s)	Male ; Humans ; Female ; Prosthesis-Related Infections/etiology ; Prosthesis-Related Infections/surgery ; Survivorship ; Prosthesis Failure ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Hip/adverse effects ; Arthritis, Infectious/etiology ; Arthritis, Infectious/surgery
Language	English
Publishing date	2023-05-11
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ZDB-ID	2898328-2
ISSN	2474-7661 ; 1067-151X
ISSN (online)	2474-7661
ISSN	1067-151X
DOI	10.5435/JAAOSGlobal-D-22-00218
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Article: Improving Technical Outcome in Osteochondral Allograft Transplantation of the Femoral Trochlea: The Role of Contoured Guides, Experience Level, Graft Size, and Graft Position.

Delman, Connor M / Haffner, Max / Rinaldi, Peter / Lum, Zach C / Jamali, Amir A / Wilson, Machelle / Lee, Cassandra A

Orthopaedic journal of sports medicine

2023 Volume 11, Issue 2, Page(s) 23259671221145208

Abstract: Background: The use of coring instrumentation for osteochondral allograft (OCA) transplantation of the femoral trochlea is challenging due to the complex topography of this anatomical area.: Purpose: We sought to determine the effect of flat guides ... ...

Abstract	Background: The use of coring instrumentation for osteochondral allograft (OCA) transplantation of the femoral trochlea is challenging due to the complex topography of this anatomical area. Purpose: We sought to determine the effect of flat guides versus guides contoured to the surface of the trochlea on graft step-off in trochlear OCAs performed on a foam bone model. We also determined the effect of surgeon experience level and graft size on step-off. Study design: Controlled laboratory study. Methods: Allograft harvesters were produced in 3 different sequential sizes with either a flat or a contoured undersurface. The guides matched one another in all aspects of shape and size except for the undersurface contour. The contoured undersurface generally matched the surface of the bone model trochlea but was not customized to that surface. A total of 72 foam femora were obtained. Identical trochlear stellate lesions of 3 different sizes (small, medium, and large) were created using 3-dimensional printed surface templates. A total of 6 surgeons (3 attending and 3 resident surgeons) performed OCAs of each trochlear lesion. Each surgeon performed 1 graft for each size and each guide type (n = 6 per surgeon). A specialized digital caliper was prepared that allowed the measurement of graft step-off to within 0.01 mm at a distance of 5 mm between the 2 sensors. The measurements were performed at 8 positions around the clockface of the grafts. Results: Grafts performed with the contoured guides had a mean step-off of 0.43 ± 0.37 mm. Grafts performed with the flat guides had a mean step-off of 0.74 ± 0.78 mm ( Conclusion: In this study, contoured grafts had significantly lower step-offs compared with flat guides. Experience level, clockface position, and graft size did not affect step-off.
Language	English
Publishing date	2023-02-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/23259671221145208
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Article ; Online: Surgical restabilization reduces the progression of post-traumatic osteoarthritis initiated by ACL rupture in mice.

Lin, Yu-Yang / Jbeily, Elias H / Tjandra, Priscilla M / Pride, Michael C / Lopez-Torres, Michael / Elmankabadi, Seif B / Delman, Connor M / Biris, Kristin K / Bang, Heejung / Silverman, Jill L / Lee, Cassandra A / Christiansen, Blaine A

Osteoarthritis and cartilage

2024

Abstract: Objective: People who sustain joint injuries such as anterior cruciate ligament (ACL) rupture often develop post-traumatic osteoarthritis (PTOA). In human patients, ACL injuries are often treated with ACL reconstruction. However, it is still unclear how ...

Abstract	Objective: People who sustain joint injuries such as anterior cruciate ligament (ACL) rupture often develop post-traumatic osteoarthritis (PTOA). In human patients, ACL injuries are often treated with ACL reconstruction. However, it is still unclear how effective joint restabilization is for reducing the progression of PTOA. The goal of this study was to determine how surgical restabilization of a mouse knee joint following non-invasive ACL injury affects PTOA progression. Design: In this study, 187 mice were subjected to non-invasive ACL injury or no injury. After injury, mice underwent restabilization surgery, sham surgery, or no surgery. Mice were then euthanized on day 14 or day 49 after injury/surgery. Functional analyses were performed at multiple time points to assess voluntary movement, gait, and pain. Knees were analyzed ex vivo with micro-computed tomography, RT-PCR, and whole-joint histology to assess articular cartilage degeneration, synovitis, and osteophyte formation. Results: Both ACL injury and surgery resulted in loss of epiphyseal trabecular bone (-27-32%) and reduced voluntary movement at early time points. Joint restabilization successfully lowered OA score (-78% relative to injured at day 14, p < 0.0001), and synovitis scores (-37% relative to injured at day 14, p = 0.042), and diminished the formation of chondrophytes/osteophytes (-97% relative to injured at day 14, p < 0.001, -78% at day 49, p < 0.001). Conclusions: This study confirmed that surgical knee restabilization was effective at reducing articular cartilage degeneration and diminishing chondrophyte/osteophyte formation after ACL injury in mice, suggesting that these processes are largely driven by joint instability in this mouse model. However, restabilization was not able to mitigate the early inflammatory response and the loss of epiphyseal trabecular bone, indicating that these processes are independent of joint instability.
Language	English
Publishing date	2024-04-30
Publishing country	England
Document type	Journal Article
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1016/j.joca.2024.04.013
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Zs.A 3828: Show issues

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Article ; Online: Osteoporosis Is Undertreated After Low-energy Vertebral Compression Fractures.

Haffner, Max R / Delman, Connor M / Wick, Joseph B / Han, Gloria / Roberto, Rolando F / Javidan, Yashar / Klineberg, Eric O / Le, Hai V

The Journal of the American Academy of Orthopaedic Surgeons

2021 Volume 29, Issue 17, Page(s) 741–747

Abstract: Introduction: Despite guidelines recommending postfracture bone health workup, multiple studies have shown that evaluation and treatment of osteoporosis has not been consistently implemented after fragility fractures. The primary aim of this study was ... ...

Abstract	Introduction: Despite guidelines recommending postfracture bone health workup, multiple studies have shown that evaluation and treatment of osteoporosis has not been consistently implemented after fragility fractures. The primary aim of this study was to evaluate rates of osteoporosis evaluation and treatment in adult patients after low-energy thoracolumbar vertebral compression fractures (VCFs). Methods: We retrospectively reviewed all patients ≥60 years old presenting to a single academic trauma center with acute thoracolumbar VCFs after a ground-level fall from 2016 to 2020 . Rates of osteoporosis screening with dual-energy x-ray absorptiometry and initiation of pharmaceutical treatment were recorded at four time points: before the date of injury, during index hospitalization, at first primary care provider follow-up, and at final primary care provider follow-up. Rates of subsequent falls and secondary fragility fractures were recorded. One-year mortality and overall mortality were also calculated. Results: Fifty-two patients with a mean age of 83 years presenting with thoracic and/or lumbar fractures after a ground-level fall were included. At a mean final follow-up of 502 days, only 10 patients (19.2%) received pharmacologic therapy for osteoporosis and only 6 (11.5%) underwent postinjury dual-energy x-ray absorptiometry evaluation. Twenty-five patients (48%) had at least one subsequent fall at a mean of 164 days from the initial date of injury. Eleven patients with subsequent falls sustained an additional fragility fracture because of the fall, including six operative injuries. One-year mortality among the 52 patients was 26.9%, and the overall mortality rate was 44.2% at the final follow-up. Discussion: Osteoporosis remains a major public health issue that markedly affects quality of life and healthcare costs. Our study demonstrates the additional need for improved osteoporosis workup and intervention among patients who have sustained VCFs. We hope that our study helps raise awareness for improved osteoporosis evaluation and treatment among spine surgeons and all medical professionals treating patients with fragility fractures. Level of evidence: Retrospective Case Series, Level IV Evidence.
MeSH term(s)	Adult ; Aged, 80 and over ; Fractures, Compression/etiology ; Fractures, Compression/therapy ; Humans ; Middle Aged ; Osteoporosis/complications ; Osteoporosis/epidemiology ; Osteoporotic Fractures/therapy ; Quality of Life ; Retrospective Studies ; Spinal Fractures/etiology ; Spinal Fractures/therapy
Language	English
Publishing date	2021-03-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200524-1
ISSN	1940-5480 ; 1067-151X
ISSN (online)	1940-5480
ISSN	1067-151X
DOI	10.5435/JAAOS-D-20-01132
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Article ; Online: The Biomechanical Effects of Simulated Radioscapholunate Fusion With Distal Scaphoidectomy, 4-Corner Fusion With Complete Scaphoidectomy, and Proximal Row Carpectomy Compared to the Native Wrist.

Saiz, Augustine / Delman, Connor M / Haffner, Max / Wann, Kathy / McNary, Sean / Szabo, Robert M / Bayne, Christopher O

The Journal of hand surgery

2021 Volume 46, Issue 12, Page(s) 1125.e1–1125.e8

Abstract: Purpose: To determine the effect of simulated radioscapholunate fusion with distal scaphoid excision (RSLF+DSE), 4-corner fusion with scaphoidectomy (4-CF), and proximal row carpectomy (PRC) on the wrist's range of motion (ROM), contact pressure, and ... ...

Abstract	Purpose: To determine the effect of simulated radioscapholunate fusion with distal scaphoid excision (RSLF+DSE), 4-corner fusion with scaphoidectomy (4-CF), and proximal row carpectomy (PRC) on the wrist's range of motion (ROM), contact pressure, and contact force in a cadaveric model. Methods: Ten freshly frozen cadaveric wrists were tested under 4 sequential conditions: native wrist, RSLF+DSE, 4-CF, and PRC. The simulated fusions were performed using two 1.6-mm Kirschner wires. The ROM in the flexion-extension and radioulnar deviation planes was evaluated. Contact area, contact pressure, and contact force were measured at the scaphocapitolunate joint for the RSLF+DSE simulation and radiocarpal joint for the 4-CF and PRC simulations. Mechanical testing was performed using a 35-N uniaxial load and pressure-sensitive film. Results: The RSLF+DSE and 4-CF groups had a decreased wrist arc ROM compared with the native wrist. The PRC group had a greater wrist arc ROM compared with the RSLF+DSE and 4-CF groups, but compared to the native wrist, it demonstrated a mildly decreased wrist arc ROM. The carpal pressure and contact force were significantly increased in the RSLF+DSE, 4-CF, and PRC groups compared with those in the native wrist. The RSLF+DSE group had the smallest increase in the carpal pressure and contact force, whereas the PRC group had the greatest increase. Conclusions: Our study validates previous findings that PRC is motion-conserving but has the greatest contact force, whereas RSLF-DSE and 4-CF may cause a decrease in the ROM but have lower contact forces. Clinical relevance: Understanding the underlying native wrist biomechanics and alterations following different surgical treatments may assist hand surgeons in their clinical decision making for the treatment of stage II scapholunate advanced collapse.
MeSH term(s)	Arthrodesis ; Carpal Bones/surgery ; Humans ; Range of Motion, Articular ; Scaphoid Bone/surgery ; Wrist ; Wrist Joint/surgery
Language	English
Publishing date	2021-04-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2021.02.028
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