Orthopaedics Research Over the Summer

uvmmedicine blogger Geordie Lonza '19
uvmmedicine blogger Geordie Lonza ’19

This is the second in a series of blog posts written by UVM College of Medicine 2016 Summer Research Fellows.

I started medical school with the inkling that I want to go into orthopaedics, which is well known as a highly competitive field. After speaking with an ortho attending and a few upperclassmen, I decided pretty early in my first year that I was going to spend my summer doing research on the musculoskeletal system. I felt as though it would be the best choice for my future career aspirations. I have a solid research background; however, all of my previous experiences have been in molecular biology. In my prior work, I learned how to run gels, PCR, qPCR, and ELISA, do immunostaining and flow cytometry, make virus, clone plasmids, and culture cells. In my “last free summer,” I desired to learn something new and research something close to my heart.

For the past month, I have been working with Dr. Bruce Beynnon, the director of research in the Department of Orthopaedics and Rehabilitation, on my summer research fellowship. My project initially began as an investigation into which image-based osteoarthritis (OA) assessment technique  best characterizes patient outcomes four  years post-anterior cruciate ligament reconstruction (ACL-R). These techniques include traditional clinical OA grading scale, quantitative tibiofemoral joint space width (JSW), magnetic resonance imaging OA knee score, or cartilage thickness profile. I wanted to determine whether visible changes on imaging that may indicate the early development of OA correlate with poorer patient quality of life, as self-reported by the patients. Dr. Beynnon and his colleagues have a large dataset on a cohort of patients that have undergone ACL-R; therefore, much of the data has already been collected and processed. The next step will be to work with a radiologist to acquire the MRI OA knee scores, and learn to assess an MRI for osteoarthritic changes.

At this point, my work has changed a bit to focus on the data Dr. Beynnon’s group has already acquired. Radiographic JSW is the classic measurement used to follow patients over time, either to look for the development or the progression of OA. However, there is literature that suggests MRI measurements of OA changes are superior. I am working on a paper comparing the radiographic JSW measurement with our MRI-derived measure of joint space, which is really a sum of the articular cartilage thicknesses on the tibia and the femur. Our findings will hopefully prompt further exploration into the utility of radiographs and MRI in patients with posttraumatic osteoarthritis (PTOA), especially with regards to longitudinal assessment of disease progression in clinical trials. Right now, there are no effective pharmacologic treatments or preventative procedures for OA, and patients with poor quality of life must resort to knee replacement to alleviate symptoms. I have countless friends who have undergone ACL-R after athletic injuries, and even my mother has had knee surgery. It saddens me to know that most of them will suffer from PTOA and may eventually need joint replacement. It would be awesome if I could contribute to the literature on methodologies for tracking osteoarthritic changes in the knees of patients who have undergone ACL-R, but even if I cannot, I know that the group here at UVM is doing amazing work that will help many future patients.

At times, I’ve wished that I was spending my summer traveling all over the world, exploring every single fun thing that Vermont has to offer, or simply hanging out in the Eastern Sierra in my hometown of Mammoth, Calif. However, I am glad that I’ve had the opportunity to work on something that interests me and that could help me toward my eventual career goal. I’ve met many wonderful people while hanging out on the fourth floor of Stafford, tried to force myself to work at a standing desk rather than sitting all day, and learned a ton about how researchers measure longitudinal progression of osteoarthritis. I’ve made new friends outside of my med school bubble, explored more of Burlington, spent time with my family in my hometown, and occasionally done absolutely nothing without feeling guilty about it. I’ve felt productive though not overwhelmed, which is absolutely necessary after the first year of medical school. Overall, my “last free summer” has been pretty awesome.

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