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Introduction
My 10th Annual Chief’s Report to the Orthopaedic Journal
at the Harvard Medical School… I can’t believe it’s been a
decade! During this time, the Massachusetts Institute of
Technology (MIT) named a new president, Susan Hockfield,
PhD, (2004) and during the past academic year, Harvard
University named a new president, Drew Gilpin Faust, PhD, and
in the fall we will be choosing our 44th President of the United
States, and will have a new Dean at Harvard Medical School.
Despite leadership changes occurring at all levels, our timehonored
sustained commitment at the MGH to patient quality
and safety, undergraduate and graduate medical education and
Orthopaedic translational research has never been stronger.
YAWKEY CENTER FOR OUTPATIENT CARE
The Yawkey Center continues to be the shining star of
outpatient programs at the MGH. Patient satisfaction with the
Center is extremely high as are the conveniences including:
parking, a wonderful cafeteria on the lobby-level as well an
embedded Radiology Unit, Orthotics, and cast and minor procedure
rooms within the Orthopaedic Center. At present we have
occupied every last inch of the third-floor and half of the second
floor and thus have begun to look for other ambulatory centers
in the North (North Shore Center for Outpatient Care), West
(MG West) and South (Brigham and Women’s/Mass General
Health Care Center at Foxborough) as sites for growth.
NEW NEIGHBOR
The Liberty Hotel
After five years of construction featuring a $150 million
price tag the new Liberty Hotel at the former 19th
Century Charles Street Jail site on Cambridge Street opened on
September 5, 2007. Heralded as Boston’s best luxury hotel, this
new facility adjacent to the Yawkey building was literally carved
out of Boston history and maintains the design and layout of
the original architecture. The Charles Street Jail was completed
in 1851 and housed inmates until May of 1990. We are pleased
to have this fabulous facility so close with its wonderful meeting
facilities. We have used the Liberty Hotel for patient families,
visiting professors, staff meetings, and other events. Lydia
Shire’s new Scampo Restaurant is fabulous!
ANOTHER NEW NEIGHBOR
Building of the 3rd Century
A new important addition to the MGH Main Campus
will be the Building of the 3rd Century (B3C) which is under
recent construction and will occupy the site of the former
Clinics Building. The opening is scheduled for 2011 and
coincides with the 200th anniversary of the MGH. The 530,000
square foot facility will house Radiation Oncology Radiology,
Radiology, Inpatient and Outpatient Surgery, and 19 new operating
rooms including increased Intensive Care Unit In-Patient
capacity. The top-five floors will add up to 150 new beds to
the institution and will increase inpatient capacity by 19%
with floors dedicated to Cancer, Neurology, and Neurosurgery
patients. Recently, Mr. Sumner Redstone, Executive Chairman
of the Board of Directors of Viacom, pledged $35 million to
develop a new Emergency Department at MGH and to relocate
and expand the existing Redstone Burn Center. As I write my
Chief’s Report, I can feel the reverberations from this new
building’s construction and I can watch through my window
the incredible machinery that is used to drive the steel supporting
piles into the bedrock for the foundation for the Building of
the 3rd Century. We all anxiously await this new arrival and, in
particular, the expanded capacity that it will give us as a result
of the thirteen new Orthopaedic OR suites. Thomas Holovacs,
MD, Chairman of the OR Operations Committee states, “It is
going to be awesome. This state-of-the-art facility will provide
improved efficiencies with the additional operating rooms and
superior digital imaging. Our Department is eagerly awaiting
the Building of the 3rd Century.”
FRANCIS HORNICEK, MD, PhD, PRESENTED WITH THE
BRIAN A. MCGOVERN, MD, AWARD FOR CLINICAL
EXCELLENCE
Francis Hornicek, MD, PhD, Chief of the Orthopaedic
Oncology Service, was among the proud recipients of the Brian
A. McGovern, MD, Award for Clinical Excellence at this year’s
MGPO Recognition Dinner on October 20, 2007. Dr. Hornicek
along with Patricia O’Malley, MD, of Pediatric Emergency
Services; and Nagagopal Venna, MD, of Neurology were presented
with The Brian A. McGovern, MD, Award for Clinical
Excellence, which recognizes physicians who best demonstrate
the qualities that the late Dr. Brian A. McGovern embodied
in clinical excellence, commitment and compassion. Dr.
McGovern, a respected MGH Cardiologist who died tragically
in 2003 was well known for his compassion and dedication to
his patients. Dr. McGovern’s many inspirational qualities; intelligence
and his good nature were all featured in a short film celebrating
his achievements and his life. MGPO Chairman and
Chief Executive Officer, David F. Torchiana, MD, presented each
of the honorees with an engraved crystal plaque and recognized
their individual achievements. Dr. Hornicek reports, “I was
honored to receive the award and it is truly a privilege to work
at the MGH with all of our outstanding physicians and staff.”
Dr. Hornicek exemplifies all of the characteristics that make our
field so special. Congratulations Dr. Hornicek, you are indeed
in a class by yourself!
MANKIN PORTRAIT UNVEILING
On November 28, 2007 we unveiled a portrait and had a
special Grand Rounds celebration in honor of Henry Mankin,
MD, Edith M. Ashley Professor Emeritus of Orthopaedic Surgery
at the Harvard Medical School. Drs. Francis Hornicek and Mark
Gebhardt were the masters of ceremony for the celebration. Dr.
Mankin was appointed Chief of Orthopaedic Surgery in 1972
and served in that capacity until 1996. For over 40 years, Dr.
Mankin been continuously funded by the National Institutes
of Health for Orthopaedic Biologic Research in the fields of
cartilage and osteoarthritis research, and bone allografting.
He developed a computer database system which currently
contains information on over 17,000 patients and more specific
information on 1200 patients who have had implanted
cadaver allografts. Dr. Mankin has published 630 articles and
book chapters about clinical and basic research. Dr. Mankin
recently published a fabulous book entitled “Pathophysiology
of Orthopaedic Disease”. Dr. Mankin has had an illustrious
inimitable career and is an amazing person!
THE ORTHOPAEDIC AMBULATORY SURGERY CENTER
The Orthopaedic Ambulatory Surgery Center (ASC) at
MGH West has been a spectacular success. It is a patient
friendly environment and state-of-the-art facility that has
been an important addition to the Department of Orthopaedic
Surgery. The ASC celebrated an important milestone recently
having performed the 5,000th case in June, 2008. In addition,
we opened our fourth room on October 1, 2008. Over the last
year, two of our new surgeons, Peter Asnis, MD, and Joseph
McCarthy, MD, each started performing hip arthroscopies at
the ASC. The Orthopaedic ASC is under the direction of Dr.
Jeffrey Wilson, Medical Director, and Claire O’Brien, RN, MBA,
CNORN, Nursing Director. The two of them have been an
incredible management team and have created an environment
that is dedicated to patient care, patient safety, and patient satisfaction.
Recently, they began to accept Anesthesia Residents
at the ASC who are taught peripheral blocks and ambulatory
anesthesia. Thank you to the ASC team members, Medical
Executive Committee, and Mr. David Gaynor for their oversight
and management of this magnificent facility.
ANNUAL DEPARTMENT RETREAT
Our Annual Department Retreat was held May 30-31, 2008
at the wonderful Chatham Bars Inn on Cape Cod. Our Retreat
occurred over a two-day period and included a Mass General
Orthopaedic Associates (MGOA) Business Meeting on Day 1.
This year we had a special speaker, Steven Miff, PhD, from
SG-2 (Sachs Group 2) an international consulting firm with
offices in Chicago, Washington, D.C. and London, who spoke
on “Emerging Trends and Growth in the Future of Orthopaedic
Care.” We had an open and lively discussion concerning market
trends in Orthopaedics and we also had an opportunity to
have several breakout sessions to discuss a variety of strategic
issues in the MGOA. Day 1’s academic program was followed
by a delicious Clambake and beach bonfire. Day 2 included
reports by James Herndon, MD, MBA, on the state of the
Harvard Combined Orthopaedic Residency Program (HCORP),
Kevin Raskin, MD, on the training and teaching of the Harvard
Medical Students and Mr. Richard Averbuch, Chief Marketing
Officer here at the MGH gave an informative and entertaining
presentation entitled, “Medical Marketing 101.” Mr. Averbuch
has tremendous experience in the health care arena and provided
our surgeons with a basic understanding of medical marketing;
he reviewed the current draft of the MGH Department
of Orthopaedic Surgery Marketing plan. The Service Chiefs and
I reported on our 2007 accomplishments and reviewed their
goals and objectives for 2008. We finished Day 2 with a golf
tournament on the Captains Golf Course in Brewster as well
as a fishing tournament directed by Captain Brian Grottkau,
MD. A great time was had by all participants, and we returned
refreshed and re-energized.
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FACULTY UPDATES
Peter Asnis, MD, has seen incredible growth in his clinical
practice as the newest member of the Sports Medicine Service.
Dr. Asnis has expanded our ability to treat hip, knee, and elbow
problems utilizing the newest Sports Medicine techniques. He
has been actively involved in assisting Thomas Gill, IV, MD, with
the care of the New England Patriots, the 2007 Eastern Division
and AFC Conference Champions, who set a league record with
18 consecutive wins. In addition, Dr. Asnis works closely with
the World Champion Boston Red Sox who are beginning yet
another fabulous season. In other exciting sport’s news, Dr.
Asnis was recently named Head Physician and Orthopedist for
the Boston Bruins! Well done Peter!
Congratulations to Joseph McCarthy, MD, Vice Chair for
Program Development on the recent opening of The Jim & Ellen
Kaplan Center for Joint Reconstruction Surgery at the Newton
Wellesley Hospital (NWH). Dr. McCarthy has been instrumental
in developing an integrated joint reconstruction center at NWH
that will ultimately include members of the MGOA as well as
the practitioners at the NWH. In addition to the fine clinical
setting, Dr. McCarthy has expanded the Harris Joint Registry at
the MGH to include the NWH Arthroplasty Service and more
recently has expanded the Arthroplasty Fellowship to include a
fifth fellow that rotates through NWH. Dr. McCarthy’s work on
total joint Arthroplasty as well as his expertise in the area of hip
arthroscopies has added immensely to the Service.
In 2007, we added the newest addition, to the Harvard
Medical School’s 37th Annual Advances in Arthroplasty Course,
an important Pre-Course Seminar, entitled, “Hip Arthroscopy
and Hip Disease in the Young.” The Pre-Course Seminar,
Co-Directed Drs. Joseph McCarthy and Peter Asnis, was wildly
successful with nearly 200 participants and provided an important
addition to our Annual Advances in Arthroplasty Course.
Dr. Asnis explains, “The First Annual Pre-Course Seminar in
Hip Arthroscopy was a great success. Experts in hip arthroscopy
from across the country and around the world participated
in this exciting course. With this course, we were able to bring
together world-class experts to discuss and debate the latest
technology and advances in the field of hip arthroscopy. Hip
arthroscopy is a relatively new field with great promise.”
Joseph Schwab, MD, the newest member of the Department
has had an impressive first year. Dr. Schwab is a member
of both the Orthopaedic Spine Center and the Orthopaedic
Oncology Service. Dr. Schwab divides his time between his
clinical activities in these two services and in basic science
research in the area of bone and soft tissue tumors. Dr. Schwab
has recently begun to collaborate with Dr. Ramnik Xavier on the
molecular pathophysiology of human chordomas. The newest
laboratory in the Department, The Laboratory of Sarcoma
Research, includes Drs. Schwab, Zhenfeng Duan, MD, PhD,
and Francis Hornicek, MD, PhD. We are pleased to have Dr.
Schwab as a member of our Department and are amazed at
his productivity! Dr. Hornicek reports, “Dr. Schwab has been
focusing his research efforts on molecular biology of chordoma.
His clinical time has been spent between the Orthopaedic Spine
and Orthopaedic Oncology services. He has clinical research
projects focusing on spine tumors and metastatic disease.
We welcome Joe and his wife, Christina Ferrone, MD, a
physician in the MGH Department of General Surgery!
It is a pleasure to welcome Gleeson Rebello, MD, to the
Department of Orthopaedic Surgery at the MGH. Dr. Rebello
will be joining Drs. Brian Grottkau and Maurice Albright and
the other members of the Pediatric Orthopaedic team as its
newest member. Dr. Rebello did his Orthopedic Residency
in India and joined the MGH as a
Peabody Research Fellow in 2004; he
followed with fellowships in Pediatric
Orthopedics, Oncology and Hip
Preservation. His expertise is in the
areas of Pediatric and Adolescent Hip,
Foot and Neuromuscular disorders. Dr.
Rebello will be working in the newly
developed North Shore Ambulatory
Care Center in the MGH family and
will be bringing his complicated cases
to the MGH Hospital for Children on the main campus. Dr.
Rebello is joined by his lovely wife Anu and their son Rahul. We
wish him the best in his new role in the Department.
NEW FACILITIES
North Shore Center for Outpatient Care
The newest addition to the MGH master plan is the North
Shore Center for Outpatient Care which is currently under
construction and is scheduled to open in the spring of 2009.
Located on Endicott Street in Danvers it is just off of Route
128. The facility will encompass the following important programs
including: Orthopaedics, Cardiology, a Cancer Center
and advanced imaging services as well as eight state-of-the-art
surgery suites. This building conceived and constructed as a
joint effort by the North Shore Medical Center (NSMC) and
the MGH, is a 125,000-square-foot Outpatient Facility and an
80,000-square-foot Medical Office Building (MOB). This site
will be the newest addition to the Orthopaedic Department
and will offer an opportunity to partner with our North Shore
colleagues to develop an important Orthopaedic Center of
Excellence in the North. Mr. David Gaynor, Executive Director
reports, “I look forward to working with our North Shore colleagues
in developing a first class Orthopaedic practice in the
Danvers Medical Office Building.” Orthopaedic Services that will
initially be included in this building are Pediatric Orthopaedics,
Hand and Upper Extremity, Orthopaedic Spine, Orthopaedic
Oncology, Foot and Ankle. Additional services will be added in
this location in the future.
BRIGHAM AND WOMEN’S/MASS GENERAL HEALTH
CARE CENTER AT FOXBOROUGH
Early next year, the Brigham and Women’s/Mass General
Health Care Center at Foxborough will open at the Patriot
Place, a 1.3 million square foot development adjacent to Gillette
Stadium, which includes shopping, entertainment and commercial
properties. The health care center will consist of a
four-story building of 93,000 square feet, directly in front of the
main gate to the stadium, and will include physician offices,
four operating rooms for outpatient surgery and advanced
diagnostic imaging technology. Thomas Gill, IV, MD, will be the
Medical Director for the Orthopaedic practice and physicians
from our Department along with colleagues from the Brigham
and Women’s Hospital (BWH) will be providing the Orthopaedic
Services at this new facility. Other specialty care services
including Cardiology, Dermatology, Plastic Surgery and General
and Gastrointestinal Surgery will be available at this new center.
Go Patriot’s Place! Go Patriots!
PRIMARY CARE ORTHOPAEDICS COURSE
The Primary Care Orthopaedics Course is a Harvard Medical
School Continuing Medical Education Course run by the MGH
Department of Orthopaedic Surgery for over twenty-two years.
Course Director, David Ring, MD, and his Co-Directors have
created incredibly broad course content to deliver the fundamentals
of musculoskeletal medicine to over 120 primary care
providers during their two day course. The course uses adult
learning methods such as case-based panel discussions and
emphasizes audience participation. This course is one of a kind
and has greatly facilitated our New England regional base with
our primary care colleagues. Dr. Ring states that, “The MGH
Department of Orthopaedics really shines at this course. I really
admire how generous and enthusiastic our very busy staff are
with their time every year and they really know how to teach.”
SERVICE UPDATES
Adult Reconstructive Surgery Service (Arthroplasty)
The Arthroplasty Service under the direction of Service
Chief and Department Vice Chair, Andrew Freiberg, MD, continues
to grow and prosper not only on the main campus but on
off-campus Newton Wellesley Hospital (NWH) facility as well.
Once again the Arthroplasty Service had an outstanding presence
at this year’s Orthopaedic Research Society and American
Association of Orthopaedic Surgeons Annual Meetings in San
Francisco, California with 19 podium presentations, posters,
and exhibits. An amazing group.
Henrik Malchau, MD, PhD, has been growing his clinical
practice and has been intimately involved in the establishment
of multiple Clinical Databases (Registries) throughout the
Department. We plan to provide evidence-based data and a clinical
registry in each of our sub-divisions of Orthopaedic Surgery.
This will be a critically important aspect of the future of our
Orthopaedic Department and will help us better analyze our own
data as it relates to other data sources throughout the region.
Dr. Malchau’s research interests include outcome documentation
of primary and revision Arthroplasties with use of highly
specialized radiographic tools such as RSA (Radiostereometric
Analysis) and DEXA, clinical questionnaires and electronic gait
activity monitoring. It is a pleasure to welcome Dr. Malchau to
the Executive Committee in his new role as the Vice Chair of
Orthopaedic Research at the MGH.
Close collaboration continues with the members of the
Arthroplasty Service and the Bioengineering Laboratory under
the direction of Guoan Li, PhD. Dr. Li reports, “We are working
closely with the surgeons to apply our robotic testing system
and dual-orthogonal fluoroscopic imaging techniques for the
most accurate measurement of human musculoskeletal joint
kinematics. Recent developments include quantification of
human knee kinematics before and after surgical treatments
such as total knee replacement, Anterior Cruciate Ligament
(ACL) or Posterior Cruciate Ligament (PCL) Reconstruction.
We are also investigating gender differences on human knee
joint function and are aiming to provide baselines for the development
of gender specific knee arthroplasties and for understanding
the mechanisms of gender related ACL injuries.”
The Adult Reconstructive Surgery Fellowship Training
Program at the MGH is one of the oldest and most renowned in
the field. We hosted the 48th Year End Party of the Fellowship
at the Capital Grill on Newbury Street. The 2007-2008 fellows:
Michael Fehm, MD; Stefan Jobodh, MD; Alvin Mok, MD; Slade
Moore, MD; and Thomas Vikoren, MD, did an outstanding job
and following their graduation spread out across the country.
Dr. Fehm stayed in the Boston area and is working out of the
Winchester Hospital, Dr. Jibodh settled in Northern California,
Dr. Mok went into practice in Redwood City, California at
the Kaiser Permanente Medical Center, Dr. Moore joined a
private practice Orthopaedic Group in North Carolina and Dr.
Vikoren went into private practice in Doylestown, Pennsylvania.
Fabulous work gentlemen!
As the Arthroplasty Service continues to grow we are in the
process of searching for a new attending. This individual will
have an outstanding practice both at the MGH as well the NWH
along with Dr. Joseph McCarthy. The candidate list is being
narrowed and I look forward to introducing our newest faculty
member in my Chief’s Report in 2009.
Podiatry Service
The MGH Podiatry Service staff under the direction of
Service Chief, Robert Scardina, DPM, provides ambulatory
foot care, including surgery and orthotic services, at the main
campus and other out-patient practice sites: Revere, Chelsea,
Charlestown, the South End Community Health Center and
Lynn Community Health Center. Our staff also covers inpatient
consultations at the MGH and Spaulding Rehabilitation
Hospital. They maintain a strong clinical relationship with
the MGH Orthopaedic Foot & Ankle Service, collaborating in
patient care.
The MGH Podiatry Residency Program is one of the
most comprehensive podiatry post-graduate training programs
in the country. The curriculum includes over twenty
(one month) non-Podiatry medical and surgical rotations,
broad and diverse longitudinal training experiences in clinical
podiatry and foot and ankle surgery, and extensive didactic
activities including new ‘on-line’ educational courseware.
During academic year’07-’08, two other area hospitals joined
the program as new training sites for foot & ankle surgery,
increasing procedure volume and diversity and teaching faculty.
We hope to soon reactivate a clerkship program for 4th
year podiatric medical students across the country, helping
to attract the best and brightest resident applicants.
The fifth annual MGH Podiatry Service Winter Lecture,
‘Biomechanics of Human Walking: Motion Analysis Laboratory
Assessment’ (guest speaker: Donna Nimec, MD) was held in
January, drawing over 50 attendees including podiatrists, physical
therapists, orthotic and orthopedic technicians, and medical
assistants from MGH and other Partners institutions.
The MGH Podiatry Service includes seven additional
attending staff members, three residents, a full-time certified
orthotic technician, and two full-time medical assistants. “We
value and respect our many longstanding relationships with
other hospital services and departments contributing to this
end, and look forward to developing new ones in the future,”
notes Dr. Robert Scardina, Chief of the Podiatry Service.
Foot and Ankle Service
The Foot and Ankle service at MGH is under the leadership
of Co-directors, Drs. Richard de Asla and George Theodore. The
service continues to grow providing care for patients in both
the Yawkey outpatient center and the MGH Sport Medicine
Center on Cambridge Street. The upcoming year is likely to see
the addition of a new full time faculty member as we look to
expand our services in communities outside of Boston.
The service continues its relationship with the MGH
Biomechanics Laboratory, under the Direction of Dr. Guoan
Li. Dr de Asla’s OREF “Career Development Award” project on
“In-vivo Kinematics of Posttraumatic Ankle Osteoarthritis,” saw
its completion this year and was presented at a podium session
at the Orthopaedic Research Society meeting in San Francisco
in March 2008. The goal of the project was to better understand
how ankle joint complex kinematics differs in arthritic ankles
as compared to normal ankles. This understanding may have
implications in future ankle joint replacement designs. We
look forward to the publication.
Dr. de Asla was invited to Shanghai China to speak at
the Chinese National Congress of Foot and Ankle Surgery in
September of 2008. Dr. de Asla will continue to participate as
an Instructional Course Lecturer at the AAOS.
The Service plans to focus on establishing a Foot and Ankle
Fellowship in 2009. Watch for many important programs from
this highly productive Service.
Hand and Upper Extremity Service
The Hand and Upper Extremity Service is led by Service
Chief, Jesse B. Jupiter, MD. Dr. Jupiter reports a continued
increase in the numbers of patients, with nearly 20% of the surgical
volume of the entire Department being seen and treated
by the Service.
The faculty of the Hand and Upper Extremity Service are
remarkably productive in scholarly activities, presentations at
regional, national, and international meetings, and are highly
sought after as visiting speakers.
The Hand and Upper Extremity has become an integral
part of the teaching service for upper limb trauma, hand, wrist
and elbow. This year, the Hand Service has integrated fellowship
rotations with the MGH Plastic Surgery Department as well as
the Hand and Upper Limb Unit of the Brigham and Women’s
and Children’s Hospitals making the Hand Fellowship, one of
the most sought after programs in the country.
Dr. David Ring continues the multidisciplinary approach to
arm illness that includes non-operative doctors (physiatrists),
certified hand therapists, and a psychologist. Interest in this
approach is growing within MGH and around New England.
Dr. Ring reports, “The number of referrals specifically for this
type of inclusive or mind/body care is increasing and they
are growing a collaboration/expansion with the Orthopaedic
Trauma Service. The degree to which depression, catastrophizing
(interpreting symptoms in the worst ways), and heightened
illness concern/health anxiety affect both pain intensity and
disability is now very well established as is the role that cognitive
behavioral therapy can have improving peace of mind and
well being.” On the research front the program has obtained
several grants and published numerous papers in the past year.
The most recent data demonstrates the degree to which effective
coping skills and cultivation of a positive intuition can limit
objective functional impairment after injury.
The Annual Richard Smith Lectureship, now in its 19th
Year, was a fabulous success. Richard Gelberman, MD, The
Fred C. Reynolds Professor and Head of the Department of
Orthopaedic Surgery, Washington University in St. Louis, presented
the Smith Oration. His topic entitled,”The Evaluation of
the Brachial Plexus,” was a wonderful summary and of special
interest to the residents who attended. Each year this program
offers an opportunity for individuals in the Boston Hand and
Upper Extremity Community to meet and present interesting
ideas, new innovative research and patient treatment modalities.
The Lectureship was attended by Jane Smith, her children
and other relatives of the late Dr. Richard Smith.
Shoulder Service
Dr. Jon JP Warner leads the Harvard Shoulder Service, a
partnership between the Massachusetts General Hospital (MGH)
and the Brigham and Women’s Hospital (BWH). Dr. Laurence
D. Higgins, Director of the Sports and Shoulder Service (BWH)
acts as the Fellowship Director for the Shoulder Service. Dr.
Thomas Holovacs is a valuable part of the Shoulder Service at
MGH and contributes to Resident and Fellowship education.
This service trains 3-4 postgraduate fellows each year and hosts
over 100 international visitors for varying periods of time ranging
from one week to one year.
Clinical growth at the MGH has continued to be very
vertical with over 900 shoulder surgeries performed by Drs.
Warner and Holovacs. The core expertise of this service is the
arthroscopic and reconstructive surgery for primary problems
of the shoulder and the management of complex revisions of
failed shoulder surgeries. Patient referrals are from the local,
regional, national and international sites.
Academic highlights have included over 40 peer review
publications this year. Members of this service have lectured
around the world. Several especially important papers were
published this year. These include:
Clavert P., Millett, PJ, Warner, JJP: “Glenoid Resurfacing:
What are the limitis to asymmetric reaming for posterior erosion?”
J Shoulder Elbow Surg. 2007 Nov-Dec;16(6):843-8;
Gomoll, AH, O’Toole, RV, Czarnecki, J, Warner, JJ: “Surgical
Experience Correlates with Performance on a Virtual Reality
Simulator for Shoulder Arthroscopy” Am J Sports Med, 2007
Jun;35(6):883-8. Epub 2007 Jan 29);
Costouros JG, Porramatikul M, Lie DT, and Warner JJP:
“Reversal of Suprascapular Neuropathy Following Arthroscopic
Repair of Massive Supraspinatus and Infraspinatus Rotator Cuff
Tears.” Arthroscopy. 2007 Nov;23(11):1152-61;
Gobezie Reuben, Zurakowski, David, Lavery, Kyle, Millett,
Peter J., Brian Cole, J., Warner, Jon J.P., “Analysis of Interobserver
and Intraobserver Variability in the Diagnosis and Treatment of
SLAP Tears Using the Snyder Classification” The American
Journal of Sports Medicine. July 2008;
Gomoll AH, Pappas G, Forsythe B, Warner JJ. “Individual
Skill Progression on a Virtual Reality Simulator for Shoulder
Arthroscopy: A 3-Year Follow-up Study”. Am J Sports Med. Vol.
36, No. 6, pg. 1139-1142, 2008;
Elhassan, B., Chung, S.T., Ozbaydar, M., Diller, D., Warner,
JP, “Scapulothoracic Fusion for Clavicular Insufficiency. A
Report of Two Cases”. J Bone Joint Surg Am 2008:90 875-880.
This year Dr. Warner was named President of The New
England Shoulder and Elbow Society (www. neses.com), a
forum for shoulder and elbow surgeons around New England to
gather in a collegial environment and discuss and argue about
the best methods of treatment for shoulder and elbow problems.
The 2008 Annual Meeting was held in Jay Peak, Vermont.
Over 140 surgeons attended the two-day event. Recently the
world’s largest live shoulder surgery course was held in Annecy,
France and Dr. Warner was one of 40 International Faculty who
performed 33 live surgeries in 3 days in front of an audience of
750 shoulder surgeons.
Other major developments include a new patient database,
which allows for prospective documentation of operative
cases and preoperative as well as postoperative outcome for
treatment of shoulder problems. Our Educational Database is
also growing to over 260 GB of videos, case studies, and case
documentations.
This year’s fellows have been very successful with their job
hunt. Dr. Robert Rolf will go into private practice in Cincinnati,
Ohio. Dr. Darren Friedman will go into private practice at NYU in
New York City, and Dr. Nata Parnes will continue his postgraduate
work in Europe as well as with Dr. Jupiter here at MGH.
Orthopaedic Oncology Service
The Orthopaedic Oncology Service is under the able direction
of Service Chief, Francis Hornicek, MD, PhD. Members
of the Orthopaedic Oncology Service have been the pioneers in
the area of transplantation in limb sparing procedures in bone
cancer patients and musculoskeletal oncology.
The Orthopaedic Oncology Service and the members of
the Medical and Radiation Therapy Service from the Center of
Sarcoma and Connective Tissue Oncology, part of the MGH
Cancer Center, provide comprehensive care for patients with
soft tissue sarcomas. They are a regional, national and international
referral center for these complex tumors. Dr. Dempsey
Springfield recently joined the service and has added enormous
depth to the areas of Resident and Fellow Education, as well
as the treatment of complex intra-pelvic sarcomas. Dr. Kevin
Raskin, Dr. Dempsey Springfield, Dr. Joseph Schwab and Dr.
Hornicek continue to divide their clinical service with addi-
tional passions including orthopaedic research and medical
student and resident education. Dr. Hornicek and Zhenfeng
Duan, MD, PhD, run the Molecular Sarcoma Laboratory and
have multiple collaborative efforts to study tumor agenesis and
stem-cell research on tumor pathogenesis.
The Musculoskeletal Tumor Fellowship, one of the mostsought
after in the country, brings together members of
Beth Israel Deaconess, The Children’s Hospital and the MGH
to develop a truly world-class Fellowship program. The
Orthopaedic Oncology group has a truly impressive past, a
highly productive present and a future that includes innovation
in many areas!
Sports Medicine Service
In October 2006, the Sports Medicine Service moved to its
new location on Cambridge Street. This new state-of-the-art facility,
MGH Sports Medicine Center, houses physician offices, exam
rooms, Radiology, Cast and Bracing, a library, conference center
and an ultra-modern physical therapy and rehabilitation suite.
Thomas Gill, IV, MD, Chief of the Sports Medicine Center
and Medical Director of the new Center, reports that they are
building a comprehensive and integrated Sports Medicine
Service as part of the Department of Orthopaedic Surgery. This
Center gives patients access to Orthopaedic Sports Medicine,
Foot and Ankle Surgery, Radiology, Physical Therapy, Bracing
and primary care. Larry Ronan, MD, of the Internal Medicine
Associates has been active in establishing the Primary Care
Sports Practice in the Center. Dr. Gill continues his roles as
Medical Director for the Boston Red Sox, a position he was
named to in 2005 and Head Team Physician for the New
England Patriots since 2006.
Dr. Peter Asnis joined the Sports Medicine Service staff
in 2006. He specializes in Sports Medicine and arthroscopic
surgery for hip disease. Dr. Asnis continues to expand his care
and his work and he continues to work as a team physician for
the Boston Red Sox, New England Patriots, the New England
Revolution and he was recently, named Head Team Physician
for the Boston Bruins. In addition, to his flourishing clinical
practice, Dr. Asnis is active with the Bioengineering Laboratory
at Massachusetts General Hospital where research is performed
to optimize treatments for patients with sports related injuries.
The newest member of the MGOA, Bertram Zarins, MD,
continues his tradition of excellence in the area of Sports
Medicine. Dr. Zarins has been on staff at the MGH for 35
years and in September 2006, was named the first Augustus
Thorndike Professor of Orthopaedic Surgery at Harvard Medical
School and the Massachusetts General Hospital. Dr. Zarins, like
Dr. Thorndike, a pioneer in the field of Orthopaedic Surgery,
will continue to focus his energies in Orthopaedic education,
clinical care, and the development of new patient care models
and educational paradigms for tomorrow’s sports medicine
practitioners. Dr. Zarins reports, “The new Sports Medicine
Center has allowed the Sports Medicine Service to grow and
to improve patient care. We have been able to greatly increase
clinical and basic research. The conference room and library
provide improved educational facilities. We are currently developing
an arthroscopy simulation learning center.”
ORTHOPAEDIC SPINE CENTER
The Orthopaedic Spine Center at the MGH is under the
skillful direction of Kirkham B. Wood, MD, and now in its 9th year
of existence. All aspects of spine care, teaching, and research
are under the auspices of this service. Our Multidisciplinary
Orthopaedic Spine Center includes: Attendings, Kirkham
Wood, MD; Joseph Schwab, MD; and Physiatrists: James Sarni,
MD; Leonid Shinchuk, MD; and David Binder, MD. In addition,
James Rathmell, MD, an anesthesiologist with the MGH Pain
Center works closely with this multidisciplinary program to
provide a full breadth of services to our patients.
Dr. Joseph Schwab, the newest member of this division, is
a member of two services, the Orthopaedic Oncology Service
and the Orthopaedic Spine Center. Dr. Schwab’s work and
interest is in metastatic disease of the spine, primary spine
tumors, and bone and soft-tissue tumors. Dr. Schwab is integrating
a highly active clinical practice along with his clinical
practice in Orthopaedic Oncology.
The Combined Harvard Spine Fellowship (BWH attendings,
Drs. Mitchell Harris and Christopher Bono) has three fellows (2 at
MGH, and 1 at BWH). The fellows are actively involved in teaching
and research programs in addition to their clinical duties.
In addition, Dr. Wood reports, that, “We have now embarked on
a fellowship and research exchange program with the Peking
University Hospital as Chinese spine surgeons visit the MGH
and participate in clinical and basic science research.”
Dr. Kirk Wood and Dr. Guoan Li, Director of the
Bioengineering, have been collaborating actively in the area
of Spine Kinematics. Dr. Wood is using the Dual-Fluoroscopic
Kinematics system to better study the kinematics of the cervical
and lumbar spine. Dr. Li explains, “The implication of this work
is to better provide excellent kinematics’ data as we move into
the field of disc replacement surgery.” In addition, Dr. Wood
has developed a spinal database along with Henrik Malchau,
MD, PhD and has been named the Co-Chair for the Adult Spine
Deformity Committee of the Scoliosis Research Society.
RESEARCH UPDATES
Bioengineering Laboratory
The Bioengineering Laboratory under the direction of
Guoan Li, PhD, continues it tradition of innovation in the area
of joint engineering and biomechanics. This year they have
begun to report their in-vivo data using their dual-orthogonal
fluoroscopic imaging technique for the accurate measurement
of in-vivo joint kinematics. This cutting-edge technique along
with the validation from the robot testing system is being
utilized to provide new concepts in Total Knee Arthroplasty,
Unicompartimental Knee Arthroplasty, knee ligament reconstruction,
upper extremity reconstruction, and the exciting area
of adult spine kinematics.
Richard de Asla, MD, and Michal Kozanek, MD, of the
Bioengineering Lab recently completed a study comparing
the kinematics of the healthy versus osteoarthritic ankles.
Dr. de Asla presented at this year’s Foot and Ankle Society
Meeting his important work on “In-vivo Kinematics of Post-
Traumatic Ankle Osteoarthritis.” Utilizing the Bioengineering
Laboratory’s dual-orthogonal fluoroscopic imaging technique,
he found that the motion coupling between a healthy ankle and
the subtalar joint is reversed in the presence of osteoarthritis of
the ankle. This finding may have implications in future ankle
surgery and joint replacement designs.
Recent development has been achieved on in-vivo human
spine research. The team is working in close collaboration with
Drs. Kirkham Wood and Brian Grottkau, to detect the effect
of scoliosis fixation on adjacent vertebral disc degeneration.
They are trying to quantify the biomechanical mechanism
of intervertebral disc deformation in normal and lower back
pain patients during daily activities. They are also working to
understand how current spinal fusion and disc replacement in
place today affect disc degeneration in adjacent vertebral levels.
Dr. Wood was recently awarded a grant from the North America
Scoliosis Society to investigate Biomechanics of scoliosis
patients. This group has recently submitted their application to
NIH for investigation of lumbar spine fusion biomechanics.
Dr. Lu Wan, recently received his PhD in Bioengineering
(MIT). His thesis was the first to investigate the in-vivo articular
contact mechanics of human ankle joints. His work has
been well reviewed in the literature including the Journal of
Osteoarthritis and Cartilage, Journal of Orthopaedic Research,
and the Journal of Biomechanics.
The lab has an increasing contingent of outstanding
graduate students from MIT, including Daniel Massimini, Ali
Hosseini, Shaobai Wang, and Kartik Varadarajan, and postdoctoral
fellows, including Drs. Samuel van de Velde, Gang Li,
Michal Kozanek, Qun Xia, Fan Liu, Jong Keun Seon and Eric
Fu. Dr. Kozanek has been studying in-vivo OA ankle joint kinematics
in collaboration with Dr. Richard de Asla and investigating
in-vivo dynamic knee kinematics in collaboration with Drs.
Rubash and Gill. Mr. Massimini continues to conduct research
on in-vivo human shoulder biomechanics in collaboration with
Dr. JP Warner as part of his Master’s degree thesis. Mr. Hosseini,
who recently passed his PhD qualifying examination continues
to investigate in-vivo ACL tension using advanced imaging
and robotic technology in collaboration with Dr. Thomas Gill
for his PhD. Drs. Xia, Li and Mr. Wang are actively studying
intrinsic biomechanics of human lumber spine in collaboration
with Drs. Kirkham Wood and Brian Grottkau. Mr. Varadarajan
made enormous progress in the investigation of “genderrelated”
in-vivo biomechanics of knee and the effect of implant
development in collaboration with Drs. Freiberg and Rubash.
Kartik Varadarajan, and co-authors won the Second Place in
PhD American Society of Mechanical Engineer’s (Marco Island,
Florida, June, 2008) student paper competition, for the work
entitled, “In-vivo kinematics and contact forces of the knee
after TKA” Dr. Samuel van de Velde, is actively publishing on
in-vivo PCL biomechanics. Dr. Fu has successfully completed a
first in-vivo human forearm kinematics study using the imaging
technique. Angela Moynihan and Hemanth Reddy Gadikota
are our core bioengineers and have actively participated in a
variety of clinical and robotic projects, including in-vivo ACL/
PCL and in-vivo TKA.
The team had over 20 talks, podium presentations, posters
and symposiums at this year’s ORS/AAOS, and Bioengineering
meetings. They published 19 papers and have 16 additional
papers accepted for publication or under peer review in biomechanics
journals over the last year and continue their enormously
successful path in the area of joint bioengineering.
The Harris Orthopaedic Biomechanics and Biomaterials Laboratory (HOBBL)
The Harris Orthopaedic Biomechanics and Biomaterials
Laboratory (HOBBL) is under the co-direction of Orthun
Muratoglu, PhD, and Henrik Malchau, MD, PhD. Members
of this laboratory have contributed to the field of Adult
Reconstructive Surgery for over four decades. A variety of different
topics have been studied and major contributions have
been made particularly in the area of implant stability, implant
fixation, bearing-surface applications, and 1st, 2nd and now
3rd Generation of highly crosslinked polyethylenes. Currently,
there are a number of outstanding clinical projects underway
at the HOBBL. Dr. Charles Bragdon is leading a staff to study
the clinial performance of first generation highly cross-linked
polyethylene and the newly FDA approved vitamine-E doped
polyethlene for use in hip and knee arthroplasties. Dr. Bragdon
has been in the laboratory for over two decades. Charlie and I
did the first canine hip replacement in the mid-eighties!
An additional clinical outcomes study in its 7th year
utilizes RSA techniques to determine the wear behavior of
crosslinked polyethylene in conjunction with the traditional as
well as large heads. This study has shown marked reduction
in wear and femoral head penetration at the 7th year benchmarks.
Dr. Malchau and co-investigators are quite pleased
with these results and state, “So far the first generation highly
crosslinked polyethylene performs as predicted in the preclinical
experiments and seems to be the bearing of choice in the
active patient.”
The HOBBL is also focusing on materials including crosslinked
polyethylene with low-wear and high strength for applications
in hip, knee and other joint arthroplasties. This section
of the HOBBL is under the direction of the Orhun Muratoglu,
PhD, an innovator in this field for over a decade. The newest
technology utilizes Vitamin E to stabilize the residual freeradicals
and to plastersize the base polymer in the second generation
polyethylene. Ebru Oral, PhD, and a group of scientists
along with Dr. Muratoglu are leading this important area of
investigation.
New exciting areas of collaboration include the area of knee
wear. Drs. Orhun Muratoglu, Henrik Malchua, Guoan Li, and I,
as well as Lars Weidenhielm, MD, PhD, and Eva Weidenhielm-
Broström, PhD, scientists who joined us from Sweden in early
September will be tackling the difficult and perplexing problem
of knee wear. This project will provide some exciting information
with the ultimate goal of detecting in-vivo wear as it
relates to implant longevity. Dr. Li states, “The innovative dual
fluoroscopic technique in a combined effort with HOBBL, is
being developed to detect in-vivo poly wear to predict longevity
of patients after TKA.”
Another new area of collaboration for HOBBL is in the
area of spine kinematics and spine reconstruction. The team is
working on technology using hydrogels as materials for intervetebral
disc replacement along with biodegradable polymer
technology. These studies could benefit many of our patients
with degenerative axial-skeleton disease as well as spinal
deformity. Dr. Kirkham Wood states, “On going studies in the
Biomechanics Lab include projects studying the three-dimensional
analysis of intervertebral disc motion using a combined
MRI-fluroscopic technique; the effects of disc degeneration
on in-vivo disc deformation and the effect of spinal deformity
surgery on adjacent segment vetebral kinematics using noninvasive
techniques.”
The HOBBL is a source of enormous activity and energy in
the area of translational and basic science research. The skillful
scientists in this laboratory had another incredible year at
the ORS and the AAOS with over 20 abstracts presented. Once
again the members of this outstanding laboratory have added a
tremendous amount of new knowledge to our field. I know that
these important contributions will continue in the future.
Laboratory of Biochemistry and Osteoarthritis Therapy
Teresa Morales, PhD, directs the Laboratory of Orthopaedic
Biochemistry and Osteoarthritis Therapy. A major interest of
the group is centered on the Insulin-like Growth Factor (IGF)
Axis, since this is a major regulator of matrix metabolism in
human articular cartilage. Dr. Morales and her team published
several papers this year relating to their work on the actions of
the IGFs and the related binding proteins (IGFBPs) in normal
and osteoarthric (OA) human cartilage. These papers documented
several important findings including that OA cartilage
is able to respond to the anabolic IGF stimulus while being
tempered by the IGFBPs--which are elevated during disease
(Morales, 2007, JOR 26:465). Moreover, the wide distribution of
IGFBP-3 in the extracellular matrix and inside the cell nucleus
was definitively shown in an OA and Cartilage paper (Hunziker
et al, 2008, 16:185) using a variety of elegant and complementary
methods including high resolution, fluorescence immunohistochemistry,
gold labeling electron microscopy and cell fractionation
studies (Sun et al, 2008, JOR DOI 10.1002/jor 20660).
The papers discussed the concept that the extracellular pools
of IGFBP-3 are likely to participate in IGF regulation, while the
intra-nuclear protein is likely to be involved in IGF-independent
gene regulatory actions. The group is now studying the potentially
critical interactions of nuclear IGFBP-3 with non-steroidal
hormone receptors such as the Vitamin A derivatives (retinoic
acid) and vitamin D elements, which are known to interact with
the binding protein in other cell types. Interest in Vitamin A
is enhanced by the fact that it is well known that its retinoic
acid derivative leads to cartilage degradation in-vitro and more
recent studies of rodents show that administration of retinoic
acid leads to cartilage atrophy. Dr. Morales also authored a
comprehensive review and analysis of current knowledge on
cartilage cell movements (Morales, OA and Cartilage 2007,
15: 861), which is another topic of interest to the group. She
keeps actively involved with the NIH and recently accepted their
invitation to be a grant reviewer this fall in her former study
section, Arthritis Connective Tissues and Skin (ACTS).
Laboratory of Musculoskeletal Engineering
The Laboratory for Musculoskeletal Tissue Engineering,
under the direction of Mark Randolph and Dr. Thomas Gill,
focuses on cartilage repair and regeneration in the knee.
Previous work funded by the AO Foundation focused on tissue
engineering strategies to repair lesions in the avascular regions
of the meniscus. The results demonstrated an efficient means
to seed chondrocytes onto polygalactin (PLGA) scaffolds, and
the capacity of this cell-scaffold constructs to heal buckethandle
lesions in swine meniscus. This study was published
in November in the American Journal of Sports Medicine in
November 2006 (Weinand C, et al, 2006, 11:34). Current studies
funded by the NFL Charities are focusing on translating
these findings from animals to preclinical studies using human
chondrocytes for cartilage healing and regeneration.
The group also continues to explore new hydrogels
for articular cartilage repair and regeneration. Working with
Drs. Robert Redmond and Irene Kochevar from the Wellman
Center of Photomedicine, they have developed a novel means
to photocrosslink collagen gel for use as an encapsulation gel
for chondrocytes and neocartilage formation. This work was
published in Tissue Engineering in 2007 (Ibusuki S et al, 13:8).
In collaboration with Dr. Kristi Anseth, at the University of
Colorado, the group has been exploring photoactive substances
that can form hydrogel scaffolds for cartilage formation, specifically
poly (ethylene glycol). Results of this were presented at the
Orthopedic Research Society in San Diego, California, in March
2007. New studies in collaboration with Dr. Orhun Muratoglu
in the Department’s Orthopedic Biomechanic and Biomaterials
Laboratory are exploring a hybrid scaffold composed of nondegradable
poly(vinyl alcohol) scaffold combined with chondrocytes
for joint cartilage replacement.
Pediatric Orthopaedic Tiss ue Engineering Laborato ry; Our
Newest Laboratory!!
The division of Pediatric Orthopaedics under the direction
of Brian Grottkau, MD, remains actively involved in clinical and
basic science research. Over the past year we have established
a Pediatric Orthopaedic Tissue Engineering Laboratory. Dr.
Chuan Ye spent one year in the lab for tissue engineering as
a fellow and completed a POSNA sponsored study on mesenchymal
stem cell transplantation for the treatment of Legg-
Calve-Perthes disease. The team hopes to present this data at
the POSNA meeting in Boston in 2009. A new postdoctoral
fellow, Yunfeng Lin, D.D.S., Ph.D., will be joining the group in
November, 2008. Dr. Lin is an accomplished tissue engineering
researcher from China who will carry on the laboratory’s
mission to expand the knowledge and orthopaedic applications
of tissue engineering over the next 3 years. They have also
completed enrollment in two prospective, randomized industry
sponsored studies on wound closure following scoliosis
surgery and bilateral lower extremity surgery in children. The
team hopes to have the data analyzed, presented and published
within the next six months. Congratulations to Dr. Grottkau on
the development of this important new laboratory!
Sarcoma and Molecular Biology Laboratory
The Sarcoma Molecular Biology Laboratory (SMBL), under
the direction of Zhenfeng Duan, MD, PhD and Francis J.
Hornicek, MD, PhD, is working on understand the mechanisms
of multi-drug resistance, identification of small molecules
and targets to reverse drug resistance, and characterization
of molecular mechanisms governing growth, proliferation of
human chordoma cells.
Dr. Duan explains, “Our laboratory investigates novel
approaches to further advance the treatment of human cancer.
The overall objectives of our laboratory are to explore biological
mechanisms of tumors arising in bone and other tissues. One
of the major focuses of the lab is to elucidate the mechanisms
of the development of drug resistance in cancer. In addition,
translational research into new treatment options for sarcoma
patients has been undertaken. Continued collaboration with
other institutions and pharmaceutical companies has provided
the foundation for evaluation of new drug development. Many
of these drugs are derived from marine sources and their corresponding
biochemical structures are quite complex.” The
Sarcoma Molecular Biology Laboratory has published articles
pertaining to multiple drug resistance in human cancer, sarcoma
biology and has received funding from a variety of
sources including NIH, foundations, corporate sponsors, and
benefactors.
The sarcoma research group at the MGH includes investigators
from multiple disciplines, as does the clinical group. We
hope to continue research expansion and further collaboration
within the Harvard community. We look forward to many
important contributions from this new laboratory.
Laboratory Updates and Renovations
Henrik Malchau, MD, PhD, and the Executive Committee
of the Department have begun a planning phase for the reorganization
of our Orthopaedic Laboratories. This plan has been
under review and has made its way through the Executive
Committee as well as the Laboratory Council. In an attempt
to focus our translational research activities and to accommodate
new areas of research in Orthopaedic Surgery including
mesenchymal stem-cells, Orthopaedic Oncology, and joint
reconstruction a multi-year laboratory renovation program has
begun. More to come!!!
DEPARTMENT HOLIDAY PARTY
This year’s annual black tie Department Holiday Party
was held at Boston’s Museum of Fine Arts. We had nearly 400
revelers in attendance. Everyone enjoyed the festive music,
decor, and of course the delicious array of foods. Many attendees
toured through the museum’s special exhibit on display,
“Symbols of Power: Napoleon and the Art of the Empire Style,
1800-1815.” Plans are underway for next year’s holiday party,
which will be held at the luxurious Seaport Hotel in South
Boston on December 20, 2008.
CHILDREN’S HOLIDAY PARTY
Our 8th Annual Children’s Holiday Party was held at the
Boston Children’s Museum. Children and their families were
greeted by an elf and entertained with holiday stories and
a magic show. After enjoying lunch, Santa and Mrs. Claus
joined the party and met with each child to hear their special
Christmas wishes. All the children left with gift from Santa and
time to explore the newly renovated museum and its’ wonderful
interactive exhibits. Next year’s Children’s Party will be held
at The Intercontinental Hotel in Boston and will bring with it
the magic of the Polar Express and other new traditions for the
children and their families.
PERSONAL NOTE
We reached some significant milestones this year. I have
been at the MGH for a decade, I am in my 25th year of practice
of Orthopaedic Surgery, and Kimberly and I celebrated our
30th wedding anniversary in August… Wow! As I reflect upon
these three significant milestones some important concepts
and similarities emerge. The first is the enormous importance
of family whether it is your colleagues, your friends, or your
spouse and children. Hard work, dedication, joy, tribulations,
and successes of your immediate and extended family are the
essential ingredients that contribute to the longevity of relationships.
The second concept is trust. Trusting the commitment
of others, their dedication to a practice, to an institution,
to a family, or to an individual, forms a foundation on which
key relationships are built. Finally, love… Love of a child, a
spouse, an associate, a friend or relative, or an institution forms
the bedrock of the foundation by which we exist.
Our family reached a new milestone this fall as Kristin, our
youngest, began her collegiate career at Wheaton College in
Norton, Massachusetts. Kristin weighed her opportunities and
decided that Wheaton represented the best education, class structure
and campus size for her goals, aspirations and equestrian
prospects. Kristin’s intellect, her enormous strength, and her
past, should prepare her for a wonderful collegiate experience.
Steve finished the School of General Studies at Boston
University and has entered the Management Program there. He
is extremely excited about pursuing this career path and he is
doing well in his fall classes. Steve completed all of the requirements
this summer and performed in an outstanding fashion.
In the future he wants to build “buildings”… I have never met
anyone with this career goal.
Brad entered his senior year at Rollins College in Florida
and he has been able to successfully blend his academic
pursuits with his extreme love of swimming. He has had an
enormously successful career in swimming and plans to use
his Anthropology major as a foundation for graduate studies
next fall.
Kimberly and I are looking forward to our first year as
“empty nesters”. Our children are concerned about our health
and well-being and each has asked, “How will we manage with
all three of the children out of the house?” Don’t worry a bit,
we’ll be OK! We are looking forward to spending some time
together, pursuing outside interests, and continuing our education.
We also hope to spend a week in Tuscany, Italy later this
fall to celebrate our 30th wedding anniversary.
Thank you all for helping me to reach these important
milestones! I am pleased and honored to be your Chairman.
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