Research

Sam Ward, PT, PhDThe Research Division continues to grow in its new home- the Altman Clinical Translational Research Center (ACTRI). This space supports 7 principal investigators who supervise approximately 50 international fellows, post-docs, residents, graduate students, staff, and undergraduate students. This operation runs on $4.5M in extramural grant support from the National Institutes of Health, National Science Foundation, Department of Defense, and the Veterans Administration per year, and generates over 70 peer-reviewed publications in Musculoskeletal Science and Orthopaedic Surgery. Our program was ranked #10 by Doximity in research output in 2017. As we move through 2018 and 2019, we are recruiting 2 new full-time scientists and continue to grow our clinical-industry partners program to expand the number of active clinical trials in the department.

UC San Diego Orthopaedic Newsletter 2018

UC San Diego Health Koman Family Outpatient Pavilion (center) recently opened and includes new orthopaedic clinical spaces and a state-of-the-art outpatient surgery center.

Message

FY 2017-2018

“I am pleased to present the FY 2017-2018 issue of the UC San Diego Department of Orthopedic Surgery Newsletter. This past year has been one of tremendous change and continued national prominence of our department. In April 2018, Steven R. Garfin, M.D., who has been our

Chairman for the past 22 years was promoted to the Interim Dean of the UC San Diego School of Medicine in recognition of his outstanding leadership and for his potential to lead the School of Medicine through the challenges and opportunities that lie ahead. It is an honor to follow in his footsteps as Interim Department Chairman.UC San Diego Orthopedic Surgery continues to be ranked in the elite list of the top 50 hospitals for Orthopedics by US News and World Report and for 2017-18 was ranked #20 and our affiliated Rady Children’s Hospital Pediatric Orthopedic Surgery group was ranked #3.Instigated by Dr. Garfin’s vision and with the leadership of Lisa Rhodes and many others, in March this year, the Koman Outpatient Pavilion opened. Orthopedic Surgery inhabits the entire 2nd floor along with Rehabilitation. The building also contains imaging services and a state of the art ambulatory surgery center with 8 operating rooms, 3 procedure rooms, spacious preoperative and postoperative and family waiting areas.Our department continues to grow. Krishna Cidambi, MD (joint reconstruction) David Dalstrom, MD (foot and ankle), William ‘BT’ Kent, MD (orthopedic trauma) and Bryan Leek, MD (hand and sports) are new faculty added this year and we have additional recruitments planned.Highlights in this issue include:

* Awards and Honors * UC San Diego Orthopedics in the News * Orthopedic Notes * Recent publications

I hope you find this newsletter of interest and I welcome feedback.

Reid Abrams, MDProfessor and Interim ChairmanDepartment of Orthopedic Surgery

Chairman’s

In MemoriamF. Richard Convery, MD (1932 –2018)We were saddened to learn of the death of one of our former faculty members, F. Richard Convery, MD. Dr. Convery re-ceived his undergraduate diploma, medical degree, and orthopaedic surgery training at the University of Washington. He was a member of the University of Washington orthopaedic surgery faculty from 1967 until 1972 when he joined UC San Diego orthopaedic surgery. He specialized in adult reconstruction where he was sought after by patients, admired by colleagues, and awarded the prestigious Kappa Delta Award for meritorious research by the American Academy of Orthopaedic Surgeons. Dr. Convery was an admired orthopaedic leader who left an indelible mark on UC San Diego.

2017 Akeson Visiting Professorship Our visiting professor was Kristy Weber, M.D., Professor and Vice Chair, Department of Orthopaedic Surgery, Director Sarcoma Program, University of Pennsylvania. Dr. Weber specializes in oncology, with her strength’s and reputation being in pediatrics. She is the 1st Vice President of AAOS.

Dr. Weber (center) with faculty and residents

• U.S. News & World Report released their 2017-2018 “Best Hospitals” rankings, and UC San Diego Orthopaedic Surgery was recognized for extraordinary medical and surgical care and ranked #20 nationally.

• Steven R. Garfin, MD was selected as Dean, UC San Diego School of Medicine and recognized as one of America’s Most Honored Professionals for 2017

• Reid A. Abrams, MD was selected as Interim Chairman, Department of Orthopaedic Surgery. He was also awarded the UCSD Division of Plastic Surgery Teacher of the Year Award for 2018, and the San Diego Orthopaedic Society Founding Father Distinguished Service Award for Outstanding Contributions to the San Diego Orthopaedic Community for 2017.

• “2017 Top Docs” in the annual San Diego Magazine “Physicians of Exceptional Excellence:” Reid A. Abrams, MD, Scott T. Ball, MD, Steven R. Garfin, MD, Bryan Leek, MD, Alexandra K. Schwartz, MD

• Samuel Ward, PhD, PT received the 2017 Marion William Career Achievement in Research Award from the American Physical Therapy Association.

• Peter O. Newton, MD; Dylan Kluck, MD; and Burt Yaszay, MD received the Scoliosis Research Society Thomas E. Whitecloud Award for the best clinical paper.

• Koichi Masuda, M.D, Robert L Sah, M.D., Sc.D. and coworkers were awarded the prestigious International Society for the Study of the Lumbar Spine (ISSLS) Prize ($20,000) for basic science for2018.

• Alan Hargens, PhD was awarded the NASA Distinguished Public Service Medal. NASA’s highest form of recognition that is awarded to any non-Government individual or to an individual who was not a Government employee during the period in which the service was performed, whose distinguished service, ability, or vision has personally contributed to NASA’s advancement of United States’ interests. He also received the Recognition Award (“hall of fame”) from the Southwest American College of Sports Medicine given for “scholarly contributions to sports medicine, exercise science, and professional organization.”

• D. C. Covey, MD received the Outstanding Service Award from the Society of Military Orthopaedic Surgeons at the AAOS Annual Meeting.

• Ian Foran, MD received the Orthopaedic Institute for Children Research Paper Award at the 2017 California Orthopaedic Association Annual Meeting.

• Natalie Voskanian-Davis, MD became a Fellow of The American College of Sports Medicine in 2018.

• Kenneth Vitale, M.D., FAAPMR was asked to serve as the Faculty Lead for the University and sign the General umbrella MOU as the primary faculty contact between UCSD and our sister University in Japan, Yokohama City University for the next 5 years 2017-2022. In 2017 he was also selected to represent UCSD along with the Dean of Medical Education, Dr. Maria Savoia, to travel to Japan and attend an international medical education summit with UCSD, National University of Singapore, Duke-NUS Medical School, and Yokohama City University. In 2018 Dr. Vitale was also elected to the board of directors of the American College of Sports Medicine, Southwest Regional Chapter for an at-large position.

Park CK, Zlomislic V, Du J, Huang BK, Chang EY, Chang DG. “Nonoperative management of a severe proximal rectus femoris musculotendinous injury in a recreational athlete: a case report.” PM R. 2018 May 31.

Bailey JF, Miller SL, Khieu K, O’Neill C, Healey RM, Coughlin DG, Sayson JV, Chang DG, Lotz JC, Hargens AR. “From the International Space Station to the Clinic: how prolonged unloading may elevate the risk for low back pain and lumbar instability.” 2017 Outstanding Paper Award Winner: Medical/Interventional Medicine in the Spine Journal

Groessl EJ, Liu L, Chang DG, Wetherell JL, Bormann JE, Atkinson JH, Baxi S, Schmalzl L. “Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial.” Am J Prev Med. 2017 Jul 17. pii: S0749-3797(17)30290-8. doi: 10.1016/j.amepre.2017.05.019. [Epub ahead of print] PMID 28735778

Chang DG, Kertesz SG. “Yoga and Low Back Pain: No Fool’s Tool.” Ann Int Med. Jun 20, 2017.

Chauhan A, Sikora-Klak J, Abrams R. Dynamic “Homemade” Digital External Fixators for Proximal Interphalangeal Joint Injuries. J Hand Surg Am. 2018 May 8.

Hubbard J, Chauhan A, Fitzgerald R, Abrams R, Mubarak S, Sanginino M. Missed Pediatric Monteggia Fractures. JBJS Rev. 2018 Jun;6(6):e2.

New Faculty • Yu-Tsun Cheng, M.D. - RCHSD • Krishna Cidambi, MD – Adult Reconstruction • David Dalstrom, M.D. – Foot and Ankle • BT Kent, MD – Orthopaedic Trauma • Bryan Leek, MD – Orthopaedic Sports Medicine

• Kathleen Rickert, M.D. - RCHSD • Bahar Shahidi, PT, PhD – ResearchNew PA’s • Hilary Hagan, PA – Trauma • Wendy Storm, PA – Inpatient • Kathy Weber, PA – Ortho NOW (urgent care)

Awards and Honors

Program Director’s CornerAlexandra K. Schwartz, MD

Another successful year for the UCSD Orthopaedic Residency Program! Four chiefs graduated on June 9, 2018 at Scripps Birch Aquarium. It was truly an amazing night celebrating the success of these wonderful residents and their bright futures. Dr. Emily Cidambi is pursuing a career in pediatric orthopedic surgery at Boston Childrens Hospital. Dr. Matthew Kinney is doing an arthroplasty fellowship at the Anderson Clinic in Alexandria, VA. Dr. Morgan Silldorff is doing an arthroplasty fellowship at the University of Southern California Keck Medical School. Dr. Kenneth Vaz is beginning his arthroplasty fellowship at Scripps Green Hospital in San Diego California. The traditional chief dinner was held at Dr. Reid Abrams’ house this year, as he is the interim chair, after Dr. Garfin was appointed Dean of UCSD Medical School. It was a wonderful evening with dinner outdoors on a balmy San Diego evening.

There were several awards presented at graduation. Dr. Kenneth Vaz was awarded best chief resident teacher by the junior residents. Dr. BT Kent was awarded the Whitehill Prize for Excellence, awarded to a junior faculty member for exemplary teaching of clinical medicine or surgery. Dr. Andrew Pennock was awarded the Dr. Wayne Akeson teaching award for all clinical faculty. Four research residents successfully completed their research year. This included Amelia Lindgren, MD whose primary project was “Femoral Capital Epiphyseal Dysplasia: A Surgeon’s Dilemma.” Preet Gurasamy, MD completed studying “Associations of Lumbar Muscle Size and Density with Vertebral Bone Density.” Kara Sarrel, MD researched “Prevention of Painful Neuromas: A Methodological and Experimental Model in Rats.” Andrew Yoo, MD focused on his project entitled “An Analysis of Paraspinal Musculature Microarchitectural Differences at the Curve Apex in Patients with Adolescent Idiopathic Scoliosis.” There were several resident awards during the year. Amanda Golding was awarded 1st Place in Basic Science Resident Research Day for her project entitled “The Effectiveness and Mechanical Properties of Chemotherapy-Impregnated Cement on Ewing Sarcoma.” She was also awarded the Jacqueline Perry Ruth Jackson Orthopedic Society resident grant. Dr. Kenneth Vaz won the COA Lloyd W. Taylor award for his paper with Dr. Francis Gonzales on “ Assessment of Early Subsidence, Periprosthetic Fracture, and Revision of Cementless Femoral Stems Via the Direct Anterior Approach.” With the rapid growth of clinical volume at Jacobs Medical Center, the residents have been working incredibly hard and the patient volume outgrew the ability to be available at all times due to other obligations at Hillcrest and Encinitas Clinic. To try and help them, we have hired a full time inpatient physician assistant, Wendy Storm, who has stepped into the role and is positively impacting patient care.

Selected PublicationsKinney MC, Nagle D, Bastrom T, Linn MS, Schwartz AK, Pennock AT. Operative Versus Conservative Management of Displaced Tibial Shaft Fracture in Adolescents. J Pediatr Orthop. 2016 Oct-Nov;36(7):661-6. PMID: 27603095

Monahan AM, Madison SJ, Loland VJ, Sztain JF, Bishop ML, Sandhu NS, Bellars RH, Khatibi B, Schwartz AK, Ahmed SS, Donohue MC, Nomura ST, Wen CH, Ilfeld BM. Continuous Popliteal Sciatic Blocks: Does Varying Perineural Catheter Location Relative to the Sciatic Bifurcation Influence Block Effects? A Dual-Center, Randomized, Subject-Masked, Controlled Clinical Trial. Anesth Analg. 2016 May;122(5):1689-95. PMID: 26962712

Aiyer A, Egol, K Parviz J, Schwartz, A, Mehta S. Orthopaedic surgery: perspectives on matching into residency. Curr Orthop Pract. 201 January/February 2016 - Volume 27 - Issue 1 - p 98–102

Foran I, Hussey V, Patel R, Sung J, Shah SB. Paraneurial tissue and adhesions alter nerve strain distribution in rat sciatic nerves. J Hand Surg (Eu), 2017.

Foran I, Upasani V, Wallace C, Britt E, Bastrom T, Bomar J, Pennock AT. Acute pediatric Monteggiafractures: A conservative approach to stabilization. J Ped Orthop, 2017; published ahead of print.

McCarthy MM, Covey DC. An unusual case of an intra-articular osseous fragment associated with a medial collateral ligament femoral avulsion fracture in an adult. JBJS Case Connect 2017;7(4):e92.

Challa ST, Hargens AR, Uzosike A, Macias BR. Muscle Microvascular Blood Flow, Oxygenation, pH, and Perfusion Pressure Decrease in Simulated Acute Compartment Syndrome. J Bone Joint Surg Am. 2017 Sep 6;99(17):1453-1459 PubMed PMID: 28872527.

Gibbons MC, Singh A, Anakwenze I, Cheng T, Pomerantz MD, Schenk S, Engler AJ, Ward SR. Histological Evidence of Muscle Degeneration in Advanced Human Rotator Cuff Disease. J Bone Joint Surg Am. 2017 Feb1:99(3)190-199.

Rodriguez-Soto AE, Berry DB, Palombo L, Valaik E, Kelly KR, Ward SR. Effect of Load Magnitude and Distribution on Lumbar Spine Posture in a Group of Active Duty Marines. Spine, Mar:42(5):345-351, 2017.

Patel VV, Andersson GBJ, Garfin, SR, Resnick DL, Block JE. Utilization of CT scanning associated with complex spine surgery. BMC Musculoskeletal Dis. 2017 Jan 31;18(1):52.

Dengler J, Duhon B, Whang P, Frank C, Glaser J, Sturesson B, Garfin S, Cher D, Rendahl A, Polly D; INSITE, iMIA, SIFI study groups. Predictors of Outcome in Conservative and Minimally Invasive Surgical Management of Pain Originating from the Sacroiliac Joint: A Pooled analysis. Spine. 2017 Mar 27.

Shahidi B, Parra CL, Berry DB, Hubbard JC, Gombatto S, Zlomislic V, Allen RT, Hughes-Austin J, Garfin S, Ward SR. Contribution of Lumbar Spine Pathology and Age to Paraspinal Muscle Size and Fatty Infiltration. Spine. 2017 Apr 115;42(8):616-623.

Shahidi B, Hubbard JC, Gibbons MC, Ruoss S, Zlomislic V, Allen RT, Garfin SR, Ward SR. Lumbar Multifidus Muscle Degenerates in Individuals with Chronic Degenerative Lumbar Spine Pathology. J Orthop Res. 2017 May 8.

Phillips D, Egol KA, Maculatis MC, Roloff KS, Friedman AM, Lvine B, Garfin S, Schwartz A, Sterling R, Kuivila T, Paragioudakis SJ, Zuckerman JD. Personality Factors Associated with Resident Performance: Results From 12 Accreditation Council for Graduate Medical Education Accredited Orthopaedic Surgery Programs. J Surg Educ. 2017 Jul 5 S1931-7204*16)30381-6

Wetherell JL, Bower ES, Johnson K, Chang DG, Ward SR, Petkus AJ. “Integrated exposure therapy and exercise reduces fear of falling and avoidance in older adults: a randomized pilot study.” Am J Geriatr Psychiatry. 2018 Apr 12.

We have four bright, enthusiastic new interns who just joined us. We received over 600 applications, chose 60 candidates for interviews, and ended up with the best of the best. Dr. John Kozy graduated from Case Western. Dr. Brendon Mitchell completed medical school at the University of Florida. Dr. Carey Politzer joined us from Duke University. Dr. Matthew Siow completed his medical education at New York University.

We held our annual “Orthopaedic Boot Camp” with these four recruits as well as three of the research residents. Boot Camp is a two-week dedicated period where the interns are exposed to the basics of orthopedic trauma, joints, spine, sports, hand, microvascular surgery, splinting and casting. There are several additional sessions throughout the year to expand their knowledge in these fields. Boot Camp is led by faculty as well as chief residents to immerse the interns in orthopaedics and expose them to the foundations of orthopaedic knowledge.

Our residents shone incredibly brightly again this year, scoring 97th percentile in the country on the annual Orthopedic In-Training Exam!!! Not only are they fun, hard-working, pleasant, caring, and dedicated physicians, they are unbelievably smart!!! Dr. Morgan Silldorff had a once in a lifetime experience by traveling to Panama City as part of Operation Walk. He was under the guidance of Dr. Francis Gonzales and their team performed over 60 arthroplasty surgeries in four days. They were even on the cover of the Panama City newspaper, highlighting their work.

If anyone is inspired by this update, we have established a fund to help send residents to theMaine Orthopaedic Surgery Review Course. All donations are greatly appreciated. You maydonate via https://medschool.ucsd.edu/som/ortho/about/Pages/Donations.aspx.

UC San Diego Orthopaedic NewsletterEditor/writer: D. C. CoveyAssistant Editor: Wendy Hess

RESEARCH GRANTS

Samuel Ward, PhD, PT:

Principal Investigator • Lumbar Spine Muscle Degeneration Inhibits Rehabilitation-Induced Muscle Recovery - NIH (NICHD) • Noninvasive measurements of muscle microstructure assessed by diffusion tensor imaging - NIH (NICHD) • Promotion of Skeletal Muscle Recovery Using an Extracellular Matrix Hydrogel in a Rabbit Model of Chronic Rotator Cuff Injury. • Recovery of Muscle Function after BTX Reverse Agents -Del Nova • Lumbar Spine Muscle Degeneration Inhibits Rehabilitation-Induced Muscle Recovery - NIH (NICHD) -3D Printing of Precision Scaffolds for Volumetric Muscle Regenera[on - NIH/NIAMS -Functional Outcomes after Mixed Motor and Sensory Nerve Cryoablation - Epimed Co-Investigator Grants • 3D Quantification of Exercise-Induced Recruitment in Pathological Paraspinal Muscles - NIH (NICHD/NCMRR) • Shahidi (PI) -Mechanisms and impact of pregnancy-induced adaptations in pelvic floor muscles - NIH (NICHD) • Alperin (PI) -The Physiological Basis of Rotator Cuff Muscle Rehabilitation: The influence of strain and exercise on muscle transcriptional activity and epigenetic control of growth - NIH (UL1TR001442) CTSA Bioinformatics Grant (Firestein)

Alan W Hargens, PhD: • Fluid Distribution before, during and after Prolonged Space Flight, NASA • Risk of Intervertebral Disc Damage after Prolonged Space Flight, NASA • Spinal Structure and Function after 90 Days Long-Duration Simulated Space Flight and Recovery NASA

BT Kent, MD Simon Schenck, PhD, Alexandra Schwartz, MD. • AAONA Research Grant Biomarkers of Neutrophil Extracellular Trap Formation and their Relationship to Adiposity in Foot and Ankle Surgery Patients

Doug Chang, MD, PhD • Rapid Saliva Test for Diagnostics of Neuro-Cognitive Disorder due to Traumatic Brain Injury (NCDT). NIH/NINDS