k cameron, m aderman, s gee, m donohue, m nocera, s marshall

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Mobile applications may be beneficial to promote self-management strategies to mitigate the risk of complications associated with the initiation and progression of post-traumatic osteoarthritis in military service members following acute traumatic knee joint injury. This study investigated the efficacy of a mobile app in facilitating behavior modification to improve function and symptomology among military service members following acute traumatic knee joint injury.

METHODS: This is a preliminary pre and post intervention analysis of a randomized control trial. Participants with acute traumatic knee joint injury, that had been cleared for unrestricted return to activity/duty, were randomized to either an intervention arm or a control arm. Participants randomized to the intervention arm were given access to a mobile app (mCare), through the DHA Mobile Health Care Environment Research system, and received standard of care (i.e., usual physical activity and usual medical appointments scheduled by participants). The mCare app was designed to educate the military service member on the following topics across five modules: (1) general joint health information, (2) self-management strategies, (3) weight-management strategies, (4) training and physical activity recommendations, and (5) occupational strategies. The mCare app was designed to educate the military service member and to facilitate behavioral change through evidence-based strategies to mitigate PTOA through increased knowledge and patient self-efficacy. Each module required 5-8 minutes to complete or ∼30 minutes to complete the intervention. Assessments were completed at the end of each module to test the participant’s knowledge on each topic. The participants in the intervention arm completed the intervention at their own pace over 2-4 weeks. The participants randomized to the control arm received standard of care without access to the intervention through the mCare app. The Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Knee Injury and Osteoarthritic Outcome Score (KOOS) were completed prior to and post-intervention approximately 6 weeks later in both arms of the study. Between limb differences pre and post intervention were evaluated in the intervention arm and the control arm using dependent t-tests and Cohen’s d effect size estimates were calculated for each comparison.

RESULTS: A total of 58 participants consented to participate in this study, with 29 randomized to the intervention arm and 29 randomized to the control arm. Participants in the intervention arm had an average age of 30.3 (±5.5) years, an average height of 174.7 (±10.3) cm, and an average mass of 79.9 (15.7) kg, while participants in the control arm had and average age of 29.8 (5.6) years, an average height of 175.1 (8.4) cm, and an average mass of 81.2 (13.3) kg. At the time of enrollment (pre-intervention), both groups reported significant differences between the injured knee and the contralateral uninjured knee for all ICOAP scales and all KOOS scales, with the exception of activities of daily living. At the time of the post-intervention assessment, approximately six weeks later, participants in the intervention arm reported no significant differences between knees for all scales; however, participants in the control arm continued to report significantly greater constant, intermittent, and total pain on the ICOAP in the injured knee compared to the uninjured knee. These differences represented moderate to large effects (Cohen’s d 0.59-1.07) for pain between the injured and uninjured knee in the control arm. At the time of post-intervention assessment, there were no functional differences between the injured and uninjured knee on all KOOS scales in the intervention arm or the control arm.  

DISCUSSION and CONCLUSION: These findings are similar to preliminary results recently reported for a smaller subset of participants; and they suggest that the intervention delivered through the mCare mobile app may contribute to improved constant, intermittent, and total pain in the intervention group but not in the control group, among military service members at increased risk for the initiation and progression of posttraumatic osteoarthritis following acute traumatic knee joint injury.

r robins, m defoor, m mcdermott s davidson, t dekker

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Chronic hip pain is a growing concern in active populations, often resulting from femoroacetabular impingement (FAI), labral pathology, or early degenerative changes. These conditions can significantly impair mobility, physical performance, and readiness. While conservative therapies remain first-line, biologic treatments such as leukocyte-poor platelet-rich plasma (LP-PRP) have emerged as potential adjuncts for managing chronic intra-articular hip pathology. LP-PRP may offer anti-inflammatory and regenerative benefits with a favorable safety profile. Despite increasing interest, evidence supporting the use of serial LP-PRP injections for hip pathology in active patient populations remains limited. This case series investigates the effectiveness of a standardized three-injection protocol of ultrasound-guided LP-PRP injections administered to patients with chronic hip pain in a military sports medicine clinic, monitored over 12 months evaluating changes in pain, function, and readiness status for active-duty members.

METHODS: Fifty-five patients underwent a series of 3 injections of LP-PRP (Arthrex ACP) over a period of 3 weeks.  All patients utilized the Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION) patient reported outcomes (PROs) database to record their response to treatment prior to injection, 6 weeks, 12 weeks, 6 months, and 1 year following injection. Functional outcomes were measured with IHOT-12, HOS-ADL, SANE, and PROMIS Physical Function (PF).  Pain was evaluated with DVPRS and PROMIS Pain Interference (PI). A MOTION readiness questionnaire was used to determine readiness to deploy among active-duty servicemembers.  Numeric variables for each PRO were expressed as mean (±SD) and discrete outcomes as absolute and relative (%) frequencies. Normality and heteroskedasticity of continuous data were assessed with Shapiro-Wilk and Levene’s test respectively. Continuous outcomes were compared with Anova, Welch Anova or Kruskal-Wallis tests according to data distribution. Discrete outcomes were compared with chi-squared or Fisher’s exact test accordingly. The alpha risk was set to 5% and two-tailed tests were used.  Finally, univariate analysis utilizing the Kruskal test allowed for comparison of survey score medians across collected survey time points. The alpha risk was set to 0.05.  Statistical analysis was performed with EasyMedStat (version 3.42).

RESULTS: While IHOT-12 and SANE did not demonstrate an association of higher scores except for a trend at 12 weeks (IHOT-12: β=12.4, [-0.65 ; 25.44], p= 0.0624; SANE: β=11.19, [-1.54 ; 23.92], p= 0.0843), HOS-ADL demonstrated an associated trend towards improved function at 1 year (β=11.37, [-0.62 ; 23.35], p= 0.0628).  PROMIS PF demonstrated no association with improved scores over 12 months (β=0.47, [-3.8 ; 4.74], p= 0.8256).  For pain outcomes, DVPRS demonstrated a trend towards improved pain at 12 weeks (β=-1.0, [-2.07 ; 0.07], p= 0.0658), and PROMIS PI demonstrated no association with improvement in scores over time through 12 months (β=-3.33, [-7.57 ; 0.91], p= 0.121).  Finally, MOTION readiness scores, completed in 7 of 18 active-duty service members, improved from 41.07 (CI±33.62) prior to treatment to 63.33 (CI±32.34) at 12 months, but multivariate analysis was not possible due to a low number of patients completing the MOTION Readiness survey.    

DISCUSSION/CONCLUSION: Results from this study demonstrate mixed results regarding function and pain in patients undergoing a series of 3 ultrasound-guided LP-PRP injections for chronic hip pain in a sports medicine clinic.  These findings suggest there may be improved function at 12 weeks with possible improvement in activities of daily living at 12 months.  This study also suggests improved pain at 12 weeks following treatment.  Finally, a series of LP-PRP injections may help improve readiness status for active-duty service members.  While this data suggests a series of 3 LP-PRP injections may improve pain and function for chronic pain in patients seen in a sports medicine clinic, further studies are warranted before ultrasound-guided LP-PRP injections are recommended for chronic hip pain in a sports medicine patient population.

r robins, m defoor, m mcdermott s davidson, t dekker

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Shoulder pain is a common complaint in military and sports medicine, frequently arising from conditions such as rotator cuff strain and tendinosis, partial-thickness tears, adhesive capsulitis, and early osteoarthritis. These disorders can significantly impair athletic performance and daily function, and are often challenging to manage with conventional therapies. In recent years, leukocyte poor platelet-rich plasma (LP-PRP) has gained attention for its potential to enhance tissue healing and modulate inflammation in musculoskeletal conditions.  While its application has been well-documented in specialized orthopedic and surgical settings, less is known about its use and effectiveness in a military general sports medicine setting, where patients present with a broad spectrum of activity levels and injury chronicity.  This case series aims to report patient reported outcomes (PROs) on patients undergoing a series of 3 LP-PRP injections utilized for various shoulder pathologies that present in a military sports medicine setting.

METHODS: Eighty-seven patient underwent a series of 3 injections of LP-PRP (Arthrex ACP) over a period of 3 weeks.  All patients utilized the Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION) patient reported outcomes (PROs) database to record their response to treatment prior to injection, 6 weeks, 12 weeks, 6 months, and 1 year following injection.  Functional outcomes were recorded with ASES, SANE, and PROMIS Physical Function (PF) outcomes measures.  Pain was evaluated with PROMIS Pain Interference (PI) and Department of Veterans Affairs Visual Pain Rating Scale (DVPRS). Numeric variables for each PRO were expressed as mean (±SD) and discrete outcomes as absolute and relative (%) frequencies. Normality and heteroskedasticity of continuous data were assessed with Shapiro-Wilk and Levene’s test respectively. Continuous outcomes were compared with Anova, Welch Anova or Kruskal-Wallis tests according to data distribution. Discrete outcomes were compared with chi-squared or Fisher’s exact test accordingly. The alpha risk was set to 5% and two-tailed tests were used.  Finally, univariate analysis utilizing the Kruskal test allowed for comparison of survey score medians across collected survey time points. The alpha risk was set to 0.05.  Statistical analysis was performed with EasyMedStat (version 3.42).

RESULTS: ASES scores improved from 59.6 (CI±16.57) prior to injection to 72.26 (CI±20.1) at 12 months.  Multivariate analysis identified LP-PRP was associated with higher ASES scores at 12 weeks (β=10.4, [2.09 ; 18.72], p= 0.0145), 6 months (β=9.65, [0.86 ; 18.45], p= 0.0317), and 1 year (β=12.65, [3.86 ; 21.45], p= 0.0051).  SANE scores also showed improvement from 59.22 (CI±20.75) to 69.85 (CI±17.97) at 12 months, with multivariate analysis demonstrating treatment associated with higher scores at 12 weeks (β=11.92, [1.62 ; 22.22], p= 0.0235), 6 months (β=12.39, [2.45 ; 22.32], p= 0.0148), and 1 year (β=10.63, [0.13 ; 21.13], p= 0.0473).  PROMIS PF in multivariate analysis were associated with higher values only at 6 months (β=4.56, [0.09 ; 9.03], p= 0.0457).  For pain, DVPRS improved from 4.84 (CI±1.98) to 3.1 (CI±2.29) at 12 weeks with a final mean value of 3.7 (CI±2.18).  Multivariate analysis found improved pain scores at all time points [6 weeks (β=-1.19, [-2.38 ; -0.01], p= 0.0483), 12 weeks (β=-1.74, [-2.75 ; -0.72], p= 0.001), 6 months (β=-1.61, [-2.59 ; -0.63], p= 0.0015), and 12 months (β=-1.14, [-2.15 ; -0.12], p= 0.0293)].  PROMIS PI did not show any decrease in pain scores at any time points with multivariate analysis [6 weeks (β=-0.09, [-5.11 ; 4.93], p= 0.9728), 6 months (β=-4.03, [-8.57 ; 0.51], p= 0.0807), 12 months (β=-3.6, [-7.97 ; 0.77], p= 0.1046)]. Of note, the “MOTION Readiness” score completed by 9 active-duty members improved from 66.56 (CI±23.13), peaking between 3-6 months (84.5 (CI±13); 85.1 (CI±8.95)) before settling at 72.42 (CI±24.96) at 12 months, with multivariate analysis not possible due to the low number of respondents. 

DISCUSSION/CONCLUSION: LP-PRP demonstrated continuous improvement of function and decreased pain over 12 months with common shoulder ailments that present in a military sports medicine population. In addition, maintenance of improved pain and function can be anticipated throughout the 12 months following treatment.

r robins, m defoor, m mcdermott s davidson, t dekker

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Knee pain resulting from osteoarthritis and chronic overuse injuries is a common complaint in military and general sports medicine clinics, often leading to functional limitations and reduced physical activity levels. As interest in orthobiologics grows, leukocyte-poor platelet-rich plasma (LP-PRP) has gained attention for its potential to reduce inflammation and promote tissue repair with a lower risk of exacerbating joint irritation. With Level I data supporting the use of LP-PRP in mild to moderate knee osteoarthritis, it is increasingly being utilized for a variety of knee pathology.  Real-world data on its clinical effectiveness in military and general sports medicine settings remain limited. This case series examines patient reported outcomes (PROs) of patients treated with a series of 3 LP-PRP knee injections in a military sports medicine setting measuring changes in pain and function over a 12-month time period.

METHODS: One hundred forty-eight patients who underwent a series of 3 LP-PRP injections (Arthrex ACP) over a 3-week period were prospectively followed for 12 months following the injections.  All patients utilized the Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION) patient reported outcomes (PROs) database to record their response to treatment prior to injection, 6 weeks, 12 weeks, 6 months, and 1 year following injection. Functional outcomes were recorded with IKDC, SANE, and PROMIS PF.  Pain Scores were recorded with DVPRS and PROMIS PI.  Numeric variables for each PRO were expressed as mean (±SD) and discrete outcomes as absolute and relative (%) frequencies. Normality and heteroskedasticity of continuous data were assessed with Shapiro-Wilk and Levene’s test respectively. Continuous outcomes were compared with Anova, Welch Anova or Kruskal-Wallis tests according to data distribution. Discrete outcomes were compared with chi-squared or Fisher’s exact test accordingly. The alpha risk was set to 5% and two-tailed tests were used.  Finally, univariate analysis utilizing the Kruskal test allowed for comparison of survey score medians across collected survey time points. The alpha risk was set to 0.05.  Statistical analysis was performed with EasyMedStat (version 3.42).

RESULTS: IKDC scores were associated with higher scores at 6 weeks (β=7.1, [1.01 ; 13.18], p= 0.0224), and trended toward higher scores at 12 weeks (β=5.9, [-0.81 ; 12.6], p= 0.0844) and 6 months (β=6.26, [-0.07 ; 12.6], p= 0.0527).  SANE scores were associated with lower scores at 12 months (β=-9.29, [-17.66 ; -0.93], p= 0.0296) with no association in change of scores in the interim.  PROMIS PF demonstrated an associated improvement at 12 weeks (β=5.17, [0.79 ; 9.54], p= 0.0211) and a trend towards improved scores at 12 months (β=2.47, [-0.37 ; 5.31], p= 0.0876).  Regarding pain, DVPRS was associated with lower pain scores at 6 weeks (β=-1.27, [-2.0 ; -0.55], p= 0.0007), 12 weeks (β=-1.24, [-2.0 ; -0.48], p= 0.0015), and 6 months (β=-0.93, [-1.57 ; -0.29], p= 0.0045).  PROMIS PI trended towards an association with lower pain scores by 12 months (β=-3.11, [-6.35 ; 0.13], p= 0.0596). Finally, 51 active-duty patients reported no change in MOTION readiness scores over the 12-month period (pre-injection: 60.54 (CI±23.12); 1 year: 65.19 (CI±35.72)).

DISCUSSION/CONCLUSON: The results from this study demonstrate that in a military sports medicine patient population, a 3-series of LP-PRP injections modestly improved early function through 6 months of follow-up with possible residual benefit at 12-month follow-up.  Modest pain improvement was noted during the 6 months following treatment, with a trend of improved pain levels diminishing between 6 and 12 months.  Finally, there was no notable change in readiness status for active-duty members undergoing LP-PRP injections for knee pathology over 1 year following treatment. These data points suggest that a series of 3 LP-PRP injections may improve function and reduce pain for 6 months with no decrease in readiness status for active-duty service members.

c brunette, f say, j johnson, b kowalski c gerber, z caolburn, m bedrin, j galvin

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

Introduction:
Osteoarthritis (OA) is a common degenerative joint disease characterized by the loss of hyaline cartilage integrity, activation of inflammatory cascades, and progressive pain and dysfunction. Although traditionally considered a localized articular process, systemic inflammation has been increasingly implicated in the pathogenesis of OA. The identification of circulating molecular biomarkers may facilitate earlier diagnosis and inform therapeutic strategies. The purpose of this study was to determine whether gene expression profiles in whole blood differ between patients with and without shoulder OA.

Methods:
A prospective, single-center cohort study was conducted in patients (ages 20–65) undergoing elective shoulder surgery at a single institution. Participants were classified into OA (n=5) and non-OA (n=44) groups based on clinical and radiographic criteria. Whole blood was collected using DNA/RNA Shield tubes, and RNA was extracted for analysis. Gene expression was quantified using the NanoString nCounter Inflammation Panel. Statistical analysis was performed using the NanoStringDiff package in R, with adjustments for the relatively small sample size of the OA group.

Results:
Among the genes analyzed, CD14 was the only transcript found to be elevated in the OA group compared to the non-OA group (p = 0.03).

Conclusion:
This preliminary investigation identifies CD14 as a potential systemic biomarker of inflammation in patients with shoulder OA. CD14 encodes a surface glycoprotein primarily expressed on monocytes and macrophages and plays a key role in innate immune activation via lipopolysaccharide (LPS) signaling. Its elevated expression suggests enhanced systemic immune activation in patients with OA. Increased CD14 expression in whole blood may reflect heightened innate immune system activity associated with OA pathophysiology. Further confirmatory studies are warranted to validate CD14 as a diagnostic or prognostic biomarker and to elucidate its mechanistic role in OA.

c gerber, f say, j dobrich, b kowalski, c brunette, j johnson, z colburn, m bedrin, j galvin

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION
Shoulder instability and superior labrum anterior-to-posterior (SLAP) tears are common causes of shoulder dysfunction that frequently necessitate surgical intervention. While the biomechanical distinctions between these conditions are well-established, the molecular mechanisms underlying their pathogenesis remain less clear. This observational, discovery-based study aimed to evaluate differential gene expression profiles in both whole blood and shoulder tissue of patients undergoing surgery for SLAP tears and shoulder instability. We hypothesized that these conditions would demonstrate distinct local inflammatory gene expression patterns, reflecting underlying differences in their molecular pathophysiology. 

METHODS
Patients aged 20–44 undergoing elective shoulder surgery for either SLAP tears (n=9) or shoulder instability (n=39) were prospectively enrolled at a single site. Whole blood samples were stabilized in DNA/RNA shield tubes, while excised shoulder tissue samples were snap-frozen immediately following surgical removal. RNA was extracted from blood and pulverized tissue. Gene expression was quantified using the nCounter Inflammatory Panel, targeting an array of pre-selected genes known to be associated with inflammation and tissue remodeling. Differential expression analysis was performed using the NanoStringDiff package for R, with statistical controls applied for potential confounders.

RESULTS
No statistically significant differences in gene expression were identified in whole blood samples between the SLAP tear and instability groups. In contrast, analysis of shoulder tissue revealed 62 genes with significantly altered expression. Of these, 40 genes were downregulated and 22 were upregulated in the SLAP tear group compared to the instability group. Notable differentially expressed genes included MMP3 (matrix metalloproteinase 3), involved in extracellular matrix degradation, and relaxin 2, implicated in tissue remodeling and inflammation.

DISCUSSION and CONCLUSION
The findings demonstrate that distinct local gene expression profiles are present in shoulder tissue of patients with SLAP tears compared to those with shoulder instability, suggesting differences in the underlying inflammatory and tissue remodeling processes. The lack of significant differences in whole blood supports the hypothesis that systemic markers may not sufficiently reflect localized pathophysiological differences. Furthermore, it emphasizes the need for local tissue sampling when evaluating molecular differences between these conditions. Differentially expressed genes such as MMP3 and relaxin 2 may serve as future targets for diagnostic or therapeutic strategies. Further studies with larger cohorts are warranted to validate these findings and assess the functional implications of these gene expression changes.

d cognetti, a sheean

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: ACL reconstruction (ACLR) remains the cornerstone of management of ACL injuries among young, active individuals. However, rates of return to pre-injury activity after ACLR remain unacceptably low among certain cohorts, particularly Service Members. Patient psychology may affect the outcomes of ACLR, and multiple reports have suggested that patients’ general mental health and resilience may play a significant and understudied role in the functional outcomes of ACLR. However, we are unaware of any reports that have described the distribution of resilience scores among a cohort of relatively young, active individuals undergoing ACLR. The Investigation into Mental Processes and Clinical Therapies (IMPACT) Study Group’s prospective observational cohort study was created to study the baseline psychological characteristics of patients undergoing ACLR and the effects of patient psychology on outcomes of ACLR.  Therefore, the purposes of this prospective analysis were to 1. Describe the distribution of baseline resilience scores among a large cohort of patients undergoing ACLR, 2. Assess for differences in baseline resilience between males and females undergoing ACLR, and 3. Describe the correlation between measures of patient psychology and general mental health. We hypothesized that women undergoing ACLR would be more likely to report lower resilience and that worse baseline mental health would be associated with lower resilience.

METHODS: Between 2023 and 2025, patients with ACLR were prospectively enrolled across an eight-site multicenter (5 civilian sites, 2 military medical treatment facilities) network. All enrolled patients completed a battery of patient reported outcome measures (PROMs) prior to ACLR. Continuous variables were summarized using medians and interquartile ranges (IQR.) Pearson’s correlation was calculated to assess the correlation between baseline resilience score, as assessed with Connor Davidson Resilience Scale (CD-RISC 10) and general mental health as measured by the Patient Reported Outcome Measurement Information System (PROMIS) Mental Health Score. Data management and data analysis were performed using SPSS Statistics software (Version 30; Chicago, IL). Correlations were two-sided, with an alpha level of 0.05.

RESULTS: One thousand sixty-one patients (541 males [50.6%], 528 males [49.4%]; median age 26.0 years (IQR 19.0, 37.0) were included in the final analysis. The cohort baseline median MARX activity score was 11.0 (IQR: 1.0, 16.0), PROMIS Physical Function (PF) 15.0 (IQR: 14.0, 17.0), PROMIS Mental Health (MH) 16.0 (IQR: 14.0, 18.0.) The median CD-RISC 10 was 32.0 (IQR: 29.0, 38.0.) Correlational analysis between biological sex and continuous study outcomes indicated that, compared to males, female subjects reported significantly lower physical activity level (r= 0.77, P = 0.021), worse mental health r= 0.79, P = 0.024), and more pain at baseline (r = -0.073, P = 0.017). No other significant differences in continuous study variables were identified between males and females. Regardless of biological sex, there was moderate positive correlation between baseline mental health and resilience (r = 0.547, P = 0.01.)

DISCUSSION and CONCLUSION: There was no difference in baseline resilience between males and females undergoing ACLR. Among the entire cohort, significant differences in multiple baseline measures were noted between males and females. In describing the distribution of resilience scores among a large population of patients undergoing ACLR, the current study will inform future, interventional trials to target modifiable risk factors for worse clinical outcomes of ACLR. We are unaware of comparably sized cohort focused specifically on patient psychology and outcomes of ACLR in the published literature.

d tennent, a sheean

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Previous studies reporting on outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) among military Service Members (SM) have indicated that a substantial proportion of patients do not return to full, unrestricted activities. However, owing to conspicuous limitations in methodology and outcomes reporting of these studies, it has been difficult to draw substantive conclusions about the prevalence of concomitant injuries, the type and frequency of specific treatments, and predictors of patients’ baseline pain and function. The Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION) provides an infrastructure for the prospective collection of baselines, injury-related information including patient reported outcome measures (PROMs) and intra-operative details. The current study is part of a broader collaborative effort between MOTION and the Multicenter Orthopaedic Outcomes Network (MOON) Knee Group to more rigorously predict the outcomes of primary ACLR among SM. We are unaware of previous efforts to employ MOTION to characterize baseline clinical information related to primary ACLR among Service Members. Therefore, the purpose of the current study was to report on the contents of MOTION database to describe: 1. Patients’ baseline, injury-specific PROMs, 2. The prevalence of concomitant injuries, and 3. Military surgeons’ treatment approaches with respect to graft type and management of concomitant chondral and meniscal injuries.

METHODS: MOTION was queried using the current procedure terminology (CPT) code 29888 to compile a list of all primary and revision ACLR as well as primary ACL repairs performed by MOTION surgeons between 2016 and 2023. A fellowship trained surgeon (X.X.X.) reviewed all operative reports, noting graft type, primary v. revision ACLR, primary ACL repair, graft type, presence or absence of meniscal tears, meniscus tear treatments, presence or absence of chondral injuries, and chondral injury treatments. All SM undergoing primary ACLR with operative reports available for review and baseline Single Assessment Numeric Evaluation (SANE), Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), International Knee Documentation Committee (IKDC) scores were included in the final analysis.

RESULTS: One thousand one hundred and nineteen patient records with CPT code 29888 were extracted from the MOTION. After applying the aforementioned inclusion criteria, 552 ACLR (551 patients) were included. There were 404 males (73.3%) and 148 females (26.7%) with a mean age of 28.2 years ± 7.6 years (range: 18-59 years.) Mean PROMs prior to ACLR were; PROMIS PF: 42.5 ± 6.2, PROMIS-PI: 57.5 ± 6.6, IKDC: 49.2 ± 14.4, SANE: 42.6 ± 22.1. Primary ACLR was performed using autograft bone patellar tendon bone in 303 (54.8%) cases, quadriceps tendon in 150 (27.3%) cases, hamstring in 52 (9.4%) cases, and allograft in 47 (8.5%) cases. Concomitant meniscus tears were noted in 341 (61.8%) cases (isolated medial tears: 121 (21.9%), isolated lateral tears: 143 (25.9%), combined medial/lateral tears: 77 (13.9%.) Sixty five of 121 (53.7%) isolated medial meniscus tears were repaired, and 68 of 143 (47.6%) isolated lateral meniscus tears were repaired. The majority of isolated medial and lateral meniscus tears were repaired via an all-inside technique (93 of 133, 69.9%.) Thirteen lateral meniscus root tear repairs were performed via transosseous tunnel technique. Concomitant chondral injuries were noted in 206 (37.3%) cases, the majority of which were Grade 1 lesions (100 of 206, 48.5%.) No treatment was performed in the majority (218 of 330, 66%) of chondral lesions.

DISCUSSION and CONCLUSION: This is the first description of MOTION ACLR with respect to baseline PROMs data, graft type, prevalence of meniscus/chondral injuries, and treatment frequencies. The prevalences of concomitant meniscus/chondral injuries were similar to what has been reported among comparable civilian cohorts undergoing ACLR. The prevalence of lateral meniscus posterior root injuries was substantially less than what has previously been reported in the literature. Subsequent analyses of these data will clarify the most significant predictors of patients’ baseline pain and function.

m aderman, m donohue, s gee, m bradley, r robins, l leclere, r waltz, m slabaugh, t dekker, j dickens, k cameron

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Active-duty military personnel and military service academy (MSA) cadets have demonstrated incidence rates of glenohumeral joint instability (GHJI) injuries approximately 20 times higher than the general population. These injuries can result in a diminished ability to meet the physical standards of the military which can ultimately lead to surgical intervention or medical separation. To decrease the incidence of GHJI injuries and mitigate the impact of these injuries on military readiness, identifying people at increased risk for sustaining a GHJI is critical. Therefore, the purpose of this study was to identify specific demographic and injury history factors associated with time to sustaining an incident GHJI injury during follow-up among MSA cadets.

METHODS: A prospective cohort study was conducted among cadets enrolled at a single United States MSA from August 2020 to August 2022. Demographic, health history, and sports participation information including sex (male, female), history of GHJI injuries (yes, no), history of surgery to correct GHJI (yes, no), current self-perceived GHJI instability in either shoulder (yes, no), and current participation in an overhead sport (yes, no) were collected at the time of consent upon accession. Participants were recruited to this study after their initial summer training during their first year at the MSA, prior to the start of the academic year. Injury surveillance was conducted among consented participants from enrollment until graduation or 16 May 2025. Any participants diagnosed with a glenohumeral dislocation or subluxation by an orthopedic surgeon, physical therapist, or athletic trainer was documented. The primary outcome of interest was time elapsed between enrollment in the study and an incident GHJI injury during follow-up. Kaplan-Meier survival estimates and univariate and multivariable Cox proportional hazards regression models were used to assess the association between both self-reported injury history and perceived joint stability and time to an incident GHJI injury while controlling for significant covariates. Descriptive statistics were calculated to quantify differences in time to injury by each covariate. Statistical significance was set at α<0.05.

RESULTS: During the study period, 1,326 participants (22% female; 18.89±1.63 y; 175.13±10.71 cm; 73.54±10.29 kg) agreed to participate in this study and 77 (26% female; 20.63±1.47 y; 174.37±10.27 cm; 75.10±11.62 kg) sustained an incident GHJI injury eligible for analysis. There were 32 dislocations and 45 subluxations diagnosed among the injured subjects. The mean time from baseline to GHJI injury was 462.88±362.77 days in participants who reported self-perceived instability at baseline, compared to 606.47±372.62 days among participants not endorsing perceptions of GHJI instability. Univariate Cox proportional hazards regression models revealed that participants reporting a history of GHJI (HR=6.370; 95% CI=3.83-10.60) and/or reporting current perceptions of GHJI in either shoulder (HR=6.085; 95% CI=3.13-11.87) at baseline were over 6 times more likely to sustain a GHJI injury during the follow-up period. Additionally, participants engaged in an overhead sport (HR=1.771; 95% CI=1.02-3.07) were 77% more likely to sustain a GHJI injury during follow-up than participants not participating in these activities. Sex (HR=1.232; 95% CI=0.74-2.05) and previous GHJI surgery (HR=0.907; 95% CI=0.28-2.89) reported at baseline were not associated with time to GHJI injury during follow-up. Kaplan-Meier survival estimates demonstrated similar results for each demographic and health history variable. Multivariable models controlling for sex and sport participation revealed that endorsing a history of GHJI (HR=6.409; 95% CI=3.79-10.83) and current self-reported perceptions of GHJI (HR=6.878; 95% CI=3.50-13.52) maintained a significant association with time to incident GHJI injury during the injury surveillance period.

DISCUSSION AND CONCLUSION: The endorsement of specific health history demographics upon accession to a MSA was associated with time to sustaining a GHJI injury during follow-up. Specifically, participants self-reported perception of GHJI and previous GHJI injury at baseline was associated with being over six times more likely to sustain an incident GHJI injury after accession. In addition to different patient-reported outcomes, demographics, and health history reported in previous research, self-reported instability in otherwise healthy MSA members may indicate they are at higher risk of sustaining a GHJI injury after accession.

k cameron, m aderman, m donohue, s gee, m bradley, r robins, l leclere, r waltz, m slabaugh, t dekker, j dickens

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: The incidence rates for glenohumeral joint instability injuries in military service members and service academy cadets has been reported to be up to 20 times higher when compared to the general population. These injuries often require surgical intervention and stabilization and they can limit function and the ability to complete mission essential tasks. As a result, these injuries have a significant impact on military and medical readiness. Despite the significant impact these injuries have, we currently have limited capacity to screen for injury risk. The purpose of this study was to examine the association between patient reported outcome measures (PROM) collected at the time of accession and time to sustaining a subsequent glenohumeral joint instability event during follow-up.

METHODS: A part of a multicenter prospective cohort study, this preliminary analysis was conducted among incoming cadets at a single United States Military Service Academy with enrollment between August 2020 and August 2022. Demographic information, including sex, health history, history of shoulder instability injuries, history of surgery for shoulder instability, and sports participation history were collected at the time of enrollment, within the first 6 weeks of accession. General (PROMIS Physical Function and Brief Resilience Scale) and shoulder specific (ASES and SANE) PROMs were collected bilaterally at the time of enrollment. Active injury surveillance was conducted among consented participants from the time of enrollment until graduation or 16 May 2025. Any participant diagnosed with a glenohumeral joint dislocation or subluxation confirmed by an orthopedic surgeon during the follow-up period was documented. The primary outcome of interest was time from enrollment until incident glenohumeral instability during follow-up. Univariate and multivariable logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (95%CI) to assess the association between baseline PROMs and the odds of incident shoulder instability injury during follow-up.

RESULTS: During the study period, 1,326 participants (22% female) consented to enroll in this study and 77 sustained an incident glenohumeral joint instability event during follow-up. The average age of participants at baseline was 18.9 (±1.63) years, their average height was 175.1 (±10.7) cm, and their average mass was 73.5 (±10.3) kg. In univariate analyses, baseline PROMIS Physical Function scores were associated with incident glenohumeral joint instability during follow-up (OR=0.93; 95%CI:0.89-0.98); however, Brief Resilience Scale scores were not (OR=0.85; 95%CI:0.59-1.24). For each point higher on the PROMIS Physical Function scale at baseline, participants were 7% less likely to sustain an incident glenohumeral joint instability event during follow-up. Baseline shoulder specific PROMs were also associated with incident glenohumeral joint instability during follow-up bilaterally for ASES and SANE scores. For the left shoulder, participants were 6 % less likely (OR=0.94;95%CI:0.89-0.99) to sustain an incident glenohumeral instability event for each point higher on the ASES and 8% less likely (OR=0.92;95%CI:0.87-0.95) for each point higher on the SANE at baseline. Similarly, for the right shoulder, participants were 4 % less likely (OR=0.96;95%CI:0.91-1.00) to sustain an incident glenohumeral instability event for each point higher on the ASES and 8% less likely (OR=0.96;95%CI:0.87-0.95) for each point higher on the SANE at baseline. Similar results were observed in multivariable models controlling for the influence of sex and history of glenohumeral joint instability at baseline.

DISCUSSION and CONCLUSION: Patient reported outcome measures collected upon accession to the military, particularly the PROMIS Physical Function scale and the SANE, appear to be associated with the subsequent risk of incident glenohumeral joint instability. Further research in a larger cohort is indicated to refine these prediction models and determine the utility of PROMs in combination with other demographic variables in estimating the risk of subsequent glenohumeral joint instability in military populations.

r Robins, h gibbs, m bradley, j dowe, l Leclere, r waltz, k cameron, m donohue, m slabaugh, t dekker, j dickens

Abstracted accepted for a rapid fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

US service academy members have a forty-times higher increased risk of sustaining a shoulder instability event during their time of enrollment compared to the general population.  As a result, great efforts have been made to identify risk factors, mitigate injury occurrence, optimize treatment, and promote return to duty strategies for those enrolled at the service academies.  A recent multi-center study effort recruited freshman at the US service academies to prospectively collect bilateral shoulder screening magnetic resonant imaging (MRI) studies.  This cohort of service academy members allows the opportunity to understand the morphology of shoulders before instability events occur and compare this morphology to post-injury scans in members who experience shoulder instability events while at the service academies.  This study also allows the opportunity to identify presence of pre-existing instability pathology in undiagnosed shoulders for matriculating freshman and compare to their contralateral uninjured side.

An IRB-approved longitudinal imaging study aimed at recruiting three consecutive years of incoming freshmen classes (graduating in 2024, 2025, and 2026) at the U.S. Air Force Academy, the U.S. Military Academy, and the U.S. Naval Academy were consented for voluntary participation to have both shoulders imaged with MRI early in their academic career.  If an individual then sustained a shoulder instability event, the pre-injury screening MRI will be available for comparison to the post-injury MRI.  Each class is currently being followed over their 4 years at the service academies and beyond into their active-duty military careers.  In the collection of the screening MRIs, we identified individuals who entered the service academies with previous histories of shoulder instability pathology in one of their shoulders allowing for comparison to the opposite non-injured shoulder. All pre-existing shoulder injury MRIs were measured and evaluated for comparison to the opposite shoulder’s screening MRI. A paired sample t test was performed to compare morphological measurements within subjects.

77 individuals were identified with shoulder instability injury when completing screening MRIs of both shoulders.  Of this number, 10 individuals had a history of bilateral instability, leaving 67 individuals identified as having shoulder instability pathology in one shoulder that was then available for comparison to their non-injured side.  A total of 132 shoulder MRIs were measured and analyzed.  Mean glenoid bone loss was significantly greater in injured shoulders compared to healthy shoulders (9.1% vs 6.2%, p<0.001). Injured shoulders also demonstrated significantly greater glenoid retroversion (8.2deg vs 1.5deg, p<0.001), and reduced posterior acromial tilt (36.2deg vs 53.1deg, p<0.001) relative to healthy shoulders. Hill Sachs Lesions (HSL) were present in 65 of 66 injured shoulders, with a mean lesion area of 0.7mm2. As of June 2025, 10 of these 67 pre-existing injured shoulders went on to have subsequent injury and shoulder stabilization surgery.

Shoulder instability events are common in young active individuals, and risk of instability is magnified when matriculating to a US service academy.  We identified 77 freshmen who presented with pre-existing shoulder instability pathology on screening MRI, and 15% of those with unilateral injury went on to have subsequent shoulder instability events requiring stabilization surgery.  In the injured shoulders, we identified a moderate rate of glenoid bone loss and glenoid retroversion, and a high rate of Hill-Sachs lesions on screening MRIs.

K Rochester, N reilly, c tucker, a marshal, g hess, b holloway, d masalleras, k ford, d goss

Abstracted accepted for a poster presentation at the 2025 American Physical Therapy Association North Carolina Chapter Annual Conference

Running is the primary form of cardiovascular exercise in all four branches of the United States military (Lovalekar, 2021). Running related injuries (RRIs) are the most common lower extremity injuries among military service members (MSMs) (Lovalekar, 2021).  Increased body mass index (BMI) has been associated with greater stress on runners’ bodies (Shiotani 2023, Jha 2023, Naderi 2020, van Poppel 2020, Wilson 2021).  This study compared three-dimensional running biomechanics between those of different BMIs three-dimensional that those with a greater BMI would run with less desirable biomechanics.

Soldiers completed an IRB approved consent form and were given a race bib with a number on it to run with it affixed with tape on their chests.  Soldiers ran 900 meters through a 12-camera (200Hz) markerless motion capture system three times. Data were processed utilizing machine learning algorithms to track the running motion and create 3D pose estimations. Soldiers were compared between BMI groups (normal BMI (NO < 25), overweight (OW >25 <30), and obese (OB >30) according to the American College of Sports Medicine criteria.) across lower extremity Hip, Knee and Ankle angles during stance phase using a one-way ANOVA with statistical parametric mapping (SPM) (p < .05).  Prospective injuries across 12 months are still ongoing and not presented in this abstract. 

A main effect was observed for a minimum of a percentage of stance phase between BMI groups for the Hip (X: 29.7%, t = 5.39; Y: 46.5%, t=5.47; Z: 34.7%, t=5.44) Knee (X: 57.4%, t=5.36; Y: 45.5%, t=5.36) and Ankle (X: 38.6%, t=5.68; Z: 22.8%, t=5.41).  Being mostly concerned with kinematics in the sagittal and frontal planes, we highlight those differences now.  Heavier Soldiers demonstrated decreased hip flexion and hip adduction.  Heavier Soldiers ran with decreased knee flexion at midstance and increased knee adduction.  Heavier Soldiers used the most plantar flexion at initial contact and not as much flexion in late stance.  There were no differences in ankle kinematics in the frontal plane.

Running with decreased sagittal plane motion at the hip and knee and increased adduction at the hip and knee may predispose heavier Soldiers for injury.  Increased hip and knee adduction has led to increased risk for injury in previous studies (Venable, 2022).  We hypothesize that running related injuries will be greater in Soldiers running with these kinematics and will have the 12-month prospective period completed NOV 2025 in time to share those results as well at CSM 2026.

N Hogaboom, m Smith, v morris, m st. laurent, x yuan, m nordstrom

Abstracted accepted for a poster presentation at the 2025 American Congress of Rehabilitation Medicine Annual Fall Conference

Neck pain is a significant problem among active-duty Service Members (ADSMs). A neck orthosis was designed as a minimally invasive device to correct forward head posture (FHP) and reduce associated neck pain. The primary study objective was to investigate the efficacy of the neck orthosis to reduce pain and improve function. Secondary objectives included evaluation of safety and treatment protocol adherence.

Participants were randomized into either immediate treatment (IT) or waitlist-control (WC) groups. Participants in the IT group received the collar and were instructed to wear it 20 minutes daily for 6 consecutive weeks. Those in the WC group continued with standard of care (SOC) treatment during first 6 weeks of study participation.

Thirty-five individuals completed the protocol (treatment n=18, control n=17). Changes in NPRS (U=259.5, p<.001, r=0.59) and NDI (U=89.5, p<.05, r=0.36) scores were significantly different between IT and WC groups. Post analyses revealed a significant main effect of time on NPRS in the IT group. Decreases of 2.0 points were observed (p<.001, r=.64), which surpassed the minimal clinically important difference of 1.3. No changes were observed in the WC group. No main effects of time on NDI were reported in either group (p>.05). Thirteen participants reported full adherence to the protocol (72.2%). Those who did not fully adhere to the protocol reported an average of 4.0±2.8 days of usage per week for 15.0±8.9 minutes per day. No serious AEs related to the protocol were reported.

The treatment protocol, which involved daily usage of the neck orthosis for six consecutive weeks, was safe and resulted in marked decreases in pain compared to a control group who received SOC treatment for neck pain. Improvements in function were observed, but these changes were not significant. Efforts should be made to improve adherence, as it is unclear how it impacted outcomes.

h allen, m holena, l allen, s zhao, r castillo, s cohen, r hurley, d scharfstein, j haythornthwaite, s raja, s wegener, c rini, f keefe, j bridges, r reeder, r thompson, d hanley, c campbell, SKOAP consortium

Treatment guidelines for knee osteoarthritis (KOA) vary across organizations, partly due to the lack of high-quality evidence. Experts disagree on the role of psychological management, pharmacologic treatments including opioids, and interventional therapies.

The Sequenced strategy for Knee OsteoArthritis Pain (SKOAP) trial is a multi-site, randomized, pragmatic clinical trial that uses a two-phase sequential design to evaluate the effectiveness of several interventions in individuals reporting KOA pain. Described here is the protocol for Phase 1 of the trial sequence which focuses on conservative treatments. All participants receive Best Practices (BP), a guideline-based approach to care that includes physical therapies, alternative treatments, and over-the-counter medications. Participants are then randomized to one of three groups: (1) BP alone, (2) BP plus duloxetine (30–120 mg/day), or (3) BP plus duloxetine and painTRAINER, a web-based, Cognitive Behavioral Therapy (CBT)-informed pain coping skills training. Phase 1 aims to determine whether the combination of duloxetine and BP improves pain compared to BP alone, and whether the combination of painTRAINER, duloxetine and BP provides additional benefit compared to duloxetine combined with BP. The analysis will include a modified Intention to Treat (mITT) approach and two Per-Protocol (PP) analyses; Receipt of Prescription (PP-ROP) and Minimum Effective Dose (PP-MinED). A third aim of Phase 1 is to identify clinical characteristics, patient-level factors, and psychosocial phenotypes that predict short- and long-term outcomes.

Findings from Phase 1 of the SKOAP trial will provide evidence on the effectiveness of non-opioid pharmacologic and psychological interventions for the treatment of painful KOA beyond established best practices. It may also help refine personalized treatment strategies.

Allen HM, Holena MM, Allen LE, Zhao S, Castillo RC, Cohen SP, Hurley RW, Scharfstein DO, Haythornthwaite JA, Raja SN, Wegener ST, Rini CM, Keefe FJ, Bridges J, Reeder R, Thompson RE, Hanley D, Campbell CM; SKOAP Consortium. Study design and protocol of a randomized, pragmatic, comparative effectiveness trial evaluating a sequenced strategy for improving outcomes in people with knee osteoarthritis pain (SKOAP): Conservative treatment evaluation. Seminars in Arthritis and Rheumatism. Volume 75. 2025. 152834. ISSN 0049-0172; doi.org/10.1016/j.semarthrit.2025.152834.

g bullock, j fallowfield, s De la motte, n arden, b fisher, a dooley, n forrest, j fraser, a gourlay, b hando, k harrison, d hayhurst, j molloy, p newman, e robitaille, d teyhen, j tiede, e williams, s williams, d van tiggleen, j van wyngaarden, r westrick, c emery, g collins, d rhon, ROMMIL Group

Introduction: A systematic approach to collecting and reporting injury data in military settings is necessary to maximize the impact of musculoskeletal injury-related research. An international consensus on recommended core data set of elements to capture and report is necessary. The purpose was to summarize the process and results from an international consensus study to establish recommended common minimum data elements for surveillance and Reporting Of Musculoskeletal injuries in the MILitary (ROMMIL).

Methods: A 10-step hybrid consensus process was performed. Knowledge users were embedded in the process for co-creation of pertinent questions, data elements, and voting. Evidence synthesis included a scoping review on the barriers and facilitators to implementing injury prevention programs, followed by a knowledge user survey. A sequential three round Delphi study refined and validated the final elements in the recommendation checklist. Consensus recommendations were presented to an international audience of stakeholders. Participants voted on each statement with 0 representing no importance, 5 somewhat important, and 10 maximum importance.

Results: The consensus recommendation includes one data principle of keeping continuous data continuous and 33 minimum data elements. Data elements include demographics, lifestyle, service branch, musculoskeletal/surgical history, exposure, and injury characteristics. The data principle endorsed by knowledge users recommends that continuous variables (e.g., age, weight, exposure) remain continuous and not categorized into groups. Dissenting viewpoints are detailed to provide fair and balanced consensus recommendations.

Conclusions: The ROMMIL checklist could be leveraged by clinicians, researchers, and knowledge users working in military settings when comparing and harmonizing data across studies, service branches, and countries. The ROMMIL checklist will support improved data synthesis to better inform evidence-based practice in military medicine, and the ability to generate more useful prognostic models to quantify injury risk.

Bullock GS, Fallowfield JL, DE LA Motte SJ, Arden N, Fisher B, Dooley A, Forrest N, Fraser JJ, Gourlay A, Hando BR, Harrison K, Hayhurst D, Molloy JM, Newman PM, Robitaille E, Teyhen DS, Tiede JM, Williams E, Williams S, VAN Tiggelen D, VAN Wyngaarden JJ, Westrick RB, Emery CA, Collins GS, Rhon DI; ROMMIL GROUP. Minimal Data Elements for Surveillance and Reporting Of Musculoskeletal injuries in the MILitary (ROMMIL) International Consensus Statement. Medicine & Science in Sports & Exercise 57(9):p 1914-1922, September 2025. | DOI: 10.1249/MSS.0000000000003737

p upadhyay, a banstola, b bhayana m wu

Photobiomodulation therapy (PBMT) alleviates fatigue and enhances mitochondrial bioenergetics, yet effects are modest when applied only to the thighs. Here, it is demonstrated that brief, non-invasive abdominal PBMT with 980 nm light (0.1 J cm−2) substantially improves endurance by preserving gut epithelial integrity and modulating microbiota. In graded treadmill protocols under anaerobic stress, combined abdomen-and-legs PBMT nearly doubles time to exhaustion versus sham by day 20 (70.23 vs 32.38 min; P < 0.0001) and remains superior at day 30 (55.56 vs 32.38 min; P < 0.0001). PBMT preserves mitochondrial cristae and mass in gastrocnemius and soleus muscles (P ≤ 0.0018), achieving a fourfold increase over sham (P < 0.0001). Abdominal PBMT maintains seven major gut phyla disrupted by intense exercise, enriches SCFA-producing taxa, reduces pathobionts, and elevates circulating and fecal butyrate, spermidine, L-carnitine, and acetylL-carnitine (all P ≤ 0.0001). Ex vivo assays under anaerobic, acidic conditions confirm PBMT-driven expansion of key anaerobes (P < 0.05–0.0001). In a lactic-acidosis model, abdominal PBMT reduces peak weight loss (≈5% vs ≈10%) and accelerates recovery. These findings establish abdominal PBMT as a non-invasive modality that reverses epithelial injury and dysbiosis, revealing translational potential for enhancing performance, rehabilitation, and managing disorders associated with dysbiosis or mitochondrial dysfunction.

P. Upadhyay, A. Banstola, B. Bhayana, and M. X. Wu, “ Photobiomodulation Strengthens Muscles via Its Dual Functions in Gut Microbiota.” Adv. Sci. (2025): e11582. https://doi.org/10.1002/advs.202511582

g bullock, j fallowfield, s De la motte, n arden, b fisher, a dooley, n forrest, j fraser, a gourlay, b hando, k harrison, d hayhurst, j molloy, p newman, e robitaille, d teyhen, j tiede, e williams, s williams, d van tiggleen, j van wyngaarden, r westrick, c emery, g collins, d rhon

The objective was to summarize the methodology used to develop the international minimum data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement. This is a recommended list of elements to be collected and reported when conducting injury surveillance research in military settings.

A Delphi methodology was employed to reach consensus. Preliminary steps included conducting a literature review and surveying a convenience sample of military stakeholders to 1) identify barriers and facilitators of military musculoskeletal injury (MSKI) prevention programs, 2) identify relevant knowledge gaps, and 3) establish future research priorities. A sequential three-round Delphi consensus survey followed, including relevant stakeholders from militaries around the world, using results to conduct an asynchronous knowledge user meeting (mixture of in-person and live video conference and recording) to explore the level of agreement among subject matter experts. Knowledge users, including former and current military service members, civilian practitioners working in military health networks, and international subject matter experts having experience with policy, execution, or clinical investigation of MSKI mitigation programs, MSKI diagnoses, and MSKI risk factors in military settings. For each round, participants scored questions on a Likert scale of 1-5. Scores ranged from No Importance (1) to Strong Importance (5).

Literature review and surveys helped inform the scope of potential variables. Three rounds were necessary to reach minimum consensus. Ninety-five, 65, and 42 respondents participated in the first, second and third rounds, respectively.

Achieving consensus across relevant knowledge users representing military organizations globally can be challenging. This paper details the methodology employed to reach consensus for a core minimum data elements checklist for conducting MSKI research in military settings and improve data harmonization and scalability efforts. These methods can be used as a resource to assist in future consensus endeavors of similar nature.

Bullock GS, Fallowfield JL, de la Motte SJ et al. Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement [version 2; peer review: 2 approved, 1 approved with reservations]. F1000Research 2025, 13:1044 https://doi.org/10.12688/f1000research.152514.2

D Rhon, P pasquina, D Teyhen

Noncombat musculoskeletal injuries are the single greatest threat to medical readiness. They also impart a tremendous burden on the Military Health System, accounting for the most medical encounters of any kind, more than double the next most common cause, mental health disorders. This has mobilized efforts to better understand injury causes, risk factors, and methods to mitigate the onset and impact of injuries. However, lack of standardization has led to great variability in how injury, risk factors, and injury-related outcomes have been defined. The variability in the definition of these terms limits the comparisons that can be made. Ultimately, this variability impacts our ability to understand the generalizability and applicability of current research. It also limits the ability to conduct meta-analysis, where data from multiple studies is combined and analyzed in aggregate, improving the precision of current research, and answering additional questions that could not be addressed by the original individual studies alone. The recent conclusion of an international effort led by the Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) workgroup to reach consensus on the recommended minimum data elements that should be collected and reported when assessing injury risk in military populations aims to help close this gap. The value of injury-related research in military medicine has the potential to substantially improve with widespread adoption of the ROMMIL checklist. Scientists working in military settings should use this checklist when planning their studies and when reporting their findings. Funders and journal editors should encourage use of the ROMMIL common data elements checklist whenever applicable.

Daniel I Rhon, Paul F Pasquina, Deydre S Teyhen, Improving the Quality of Musculoskeletal Injury Research in Military Settings: Introducing the Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) Common Data Element Checklist, Military Medicine, 2025;, usaf363, https://doi.org/10.1093/milmed/usaf363

A tenforde, l pham, l gaudette, m funk, k vogel, m bruneau, x yuan, j schroeder, b isaacson, N hager, e metzger, d nolan, j tam, k silbernagel

Non-insertional Achilles tendinopathy (AT) is a common running injury. Exercise loading programme (EXER) is the primary treatment. Other options include radial pressure wave (RPW, commonly referred to as shockwave) and photobiomodulation therapy (PBMT). We hypothesised that EXER+RPW and EXER+RPW+PBMT would result in greater reduction in symptoms measured using the eight-item Victorian Institute of Sports Assessment-Achilles (VISA-A) and greater improvement in functional outcomes compared with EXER. A secondary aim was to explore outcomes using elective treatment for three additional months.

Forty-six runners enrolled (24 males, 22 females; average age±SD:40±12 years). Runners assigned EXER+RPW had a greater improvement than EXER at 3 months in VISA-A (mean 33 vs 18 points, p=0.023; 95% CI 28.4 to 2.4), and no differences were detected between EXER+RPW+ PBMT and EXER (25 vs 18 points, p=0.12; 95% CI 25.9 to –10.8). There were greater improvements in running index measures, pain interference and social roles in EXER+RPW compared with EXER. VISA-A increased over 3 month crossover to EXER+RPW and EXER+RPW+PBMT (11 points, both p<0.05 compared with EXER).

There were 246,041 unique individuals in the cohort with a mean(SD) age of 37.9(12.3) years, 21.9% female, 63.1% on active duty, and 76.3% enlisted. Most patients were initially seen in a primary care setting (80.2%), followed by specialty care (16.7%) and emergency care(3.1%), and 44.4% of the patients were seen by physicians. Across all settings and clinician types, non-specific shoulder diagnosis (i.e. non-specific or unspecified shoulder pain) was the most common (73.9%), followed by rotator cuff-related pain disorders (15.9%), multiple specific diagnoses (3.7%), glenohumeral osteoarthritis (2.0%), and hypomobility disorders (1.8%). Patients who saw a specialty care non-physician were more likely to receive exercise or physical therapy than other clinician-location types, which was fairly consistent across all diagnostic groups.

Combined EXER and RPW had the largest measured reduction in symptoms at 3 months. However, all groups met clinical improvement, highlighting the importance of EXER. Larger studies in other physically active populations may clarify clinical benefits of each treatment.

Tenforde AS, Pham L, Gaudette LW, Funk MM, Vogel KE, Bruneau MM, et al. Exercise, radial pressure waves, and photobiomodulation for management of non-insertional Achilles tendinopathy in runners: a three-arm non-blinded randomised control trial. BMJ Open Sport & Exercise Medicine. 2025;11:e002442. https://doi.org/10.1136/bmjsem-2024-002442

D Rhon, M horn, h Lee, s Morton-Oswald, S George

Shoulder pain is common, can arise from various causes and has a highly variable prognosis. Treatment may differ based on the clinician delivering the care and initial care settings (primary, specialty, or emergency care). The purpose of this study was to investigate how the management of shoulder pain differs depending on clinical care settings and clinician type.

This was an observational cohort study. Using routinely collected health information from Military Health System electronic medical records and claims data, we assessed initial care setting and provider types for common shoulder disorders that occurred between July 1, 2013, and March 31, 2019. We identified shoulder-related care using current procedural terminology (CPT) and ICD-10 diagnosis codes marked in encounters within three months of initial diagnosis. Care was categorized into pharmacological treatment, non-pharmacological treatment, and imaging procedures, and compared across initial care settings and provider types.

There were 246,041 unique individuals in the cohort with a mean(SD) age of 37.9(12.3) years, 21.9% female, 63.1% on active duty, and 76.3% enlisted. Most patients were initially seen in a primary care setting (80.2%), followed by specialty care (16.7%) and emergency care(3.1%), and 44.4% of the patients were seen by physicians. Across all settings and clinician types, non-specific shoulder diagnosis (i.e. non-specific or unspecified shoulder pain) was the most common (73.9%), followed by rotator cuff-related pain disorders (15.9%), multiple specific diagnoses (3.7%), glenohumeral osteoarthritis (2.0%), and hypomobility disorders (1.8%). Patients who saw a specialty care non-physician were more likely to receive exercise or physical therapy than other clinician-location types, which was fairly consistent across all diagnostic groups.

Diagnostic subgroups of shoulder pain and initial care settings influence practice variability between physician and non-physician management of shoulder pain. Additionally, three out of every 4 patients received a non-specific shoulder diagnosis. These findings highlight the lack of coding using specific diagnostic labels, which prevents a deeper assessment of care care variability across specific shoulder diagnostic subgroups. Initial care settings should also be considered when exploring variability in care pathways for shoulder disorders.

Rhon DI, Horn ME, Lee HJ, Morton-Oswald S, George SZ. Treatment variability for shoulder pain between physician and non-physician clinicians based on initial setting and specific shoulder diagnosis: a health system analysis. BMC Health Serv Res. 2025 Oct 16;25(1):1370. doi: 10.1186/s12913-025-13175-w. PMID: 41094472; PMCID: PMC12529843.