In his study, Dr. Alqueza developed a mouse pup intra-articular injection protocol to affect gene and protein expression using in vivo electroporation as a method of transfecting plasmids into cells. This model is the first of its kind. The pups tolerated the electroporation. Green fluorescent protein (GFP) was expressed 91% of the time. To date, only the first 4 pups were sectioned and viewed histologically. GFP expressing cells were found intra-articularly in these mice. There were no infections or knee injuries. One pup out of 24 died from the procedure for unknown reasons. The investigators were able to develop a mouse pup intra-articular injection protocol to affect gene and protein expression. The investigators hope to perfect this method to study the expression of proteins in vivo, i.e. the testing of promoter regions of the proteins of interest such as lubricin.

Dr. Rosen congratulated Dr. Alqueza on the translational aspects of his study in which the need to modify the entire mouse genome was obviated by the use of a plasmid vector. In addition, Dr. Alqueza’s research shed light on the study of joint homeostasis. She posed the question of looking at cell surface receptors as a means of studying cell signaling. Dr. Weinstein raised the question of the direct target cells and stressed the need for future research to be devoted to studying chondrocytes.

In her study Dr. Dawson addressed some of the pitfalls of arthroscopic lateral release for anterior and lateral knee pain by looking at the clinical efficacy of open lateral retinacular closure (LRC). She identified 22 patients who underwent diagnostic knee arthroscopy and underwent LRC. All patients had previously undergone arthroscopic lateral release. All patients had a defect over the lateral patella retinaculum and positive medial patellar apprehension test. Rationale and timing of prior LR surgery, arthroscopic findings prior to LRC, and duration between surgeries were analyzed. She also analyzed pre-operative and post-operative Lysholm Knee Scores, activity level assessments, and subjective satisfaction ratings. Mean preoperative Lysholm knee score was 46.5 (range 25-90), which improved post-operatively to a mean score of 86 (range 48-100). Eighty-six percent of patients subjectively rated their pre-operative function as poor and fourteen percent as fair. Post-operatively, eighty-two percent rated themselves as good or excellent and eighteen percent as fair, with all patients improving from the LRC procedure. Dr. Dawson concluded that open lateral retinacular closure provides significant pain relief and improvement in functional knee outcome scores in patients with persistent tenderness at the site of a previous lateral release and a positive medial patellar apprehension test.

Dr. Berkson discussed Dr. Dawson’s paper and applauded the scope of the paper and uniformity of the patient population. He posed the clinical question of how she plans to use a lateral release in her practice. Dr. Weinstein stressed complex nature of the knee structures including the retinaculum, synovium and cartilage as pain generators. Dr. Gill shared his surgical expertise on his indications for a lateral release.

Dr. Hamilton investigated the complication rates during pregnancy and childbirth in women orthopedic surgeons. She hypothesized that women surgeons have higher rates of complications during pregnancy and childbirth than the general population related to prolonged work hours, lifting, standing and heavy physical load bearing associated with the profession, and advanced maternal age. Her secondary aims were to assess levels of satisfaction with timing of pregnancies, number of children, breastfeeding durations, time-off after delivery and overall pregnancy and childbirth experience. A 199 item questionnaire based on the original study by the last author, Dr. Lerner et al, was created. Questions relating to all aspects of pregnancy, childbearing, and maternity leave were included. They also collected basic demographic information, including training, residency, fellowship, work environment, and satisfaction. Nine specialties were captured in total: general surgery, gynecology, neurosurgery, ophthalmology, orthopaedics, otolaryngology, plastic surgery, podiatry, and urology. A total of 1066 survey responses were collected. Two-hundred and twenty-three collected were from women trained as orthopaedic surgeons representing 20.9% of all respondents. One hundred and twenty-seven of the 223 women reported having children with a total of 266 individual pregnancies for analysis. The overall rate of complication in all pregnancies of orthopedic surgeon respondents is 31.9%. The reported rate of infertility was 30.4% for orthopedic surgeons and 32.8% for all other surgical specialties. She also found a high reported rate of congenital abnormalities with a rate of 7% in all pregnancies of orthopaedic surgeons and 8.9% in all other surgical specialists. She concluded that women orthopedic surgeons appear to have higher rates of complication during pregnancy and childbirth.

Dr. Rubash noted the bimodal inflection points for females with preterm labor. He raised the question of the need for a specific policy for pregnant females in the workplace. Dr. Gebhardt noted the financial difficulty in covering for residents on leave. Dr. Vrahas also noted that while residents are on leave, they not only miss work and experience, but they miss educational opportunities.