b barlow, a sheean, b gillingham

Despite the dedicated efforts of a wide breadth of musculoskeletal (MSK) physicians and providers across the Military Health System (MHS), musculoskeletal injuries (MSKIs) continue to represent the most significant threat to the readiness, deployability and retention of United States military personnel. MSK readiness is warfighter readiness. There is a compelling need to align and integrate the multitude of programs and initiatives currently in place and to increase the number and value of civilian military partnerships. We must use and share existing data repositories, such as the Military Orthopaedic Tracking Injuries and Outcomes Network, to guide our MSK research agenda with the goal of eliminating preventable injuries and to optimize the care we provide for unavoidable MSK injuries and diseases. Formalizing relationships among the current military and civilian organizations and programs focused on MSK prevention and treatment is also a critical necessity. Enhanced collaboration between the Society of Military Orthopedic Surgeons, the Military Advanced Surgical Training initiative, the Consortium for Health and Military Performance and the Musculoskeletal Injury Rehabilitation Research for Operational Readiness programs at the Uniformed Services University will pay tremendous readiness dividends when their efforts are formally aligned and integrated with the Defense Health Agency and the service medical departments. This will also create the foundation necessary for the MHS to establish itself as a national exemplar for the provision of value based MSK care. Despite the existence of a robust database, skilled practitioners, and the backing of academic and civilian expertise, there is room for improvement in our ability to improve the outcomes of the MSK care we provide. We need to integrate and share siloed data to optimize the operative and non-operative MSK care we provide. We also need to foster enhanced collaboration among all the entities dedicated to decreasing the burden of MSK injuries and disease on both our warfighters and our veterans. The essential elements are there but lack the alignment and integration necessary to optimize MSK readiness. With the commitment of engaged MHS leadership, concerted effort at the point of care, and increased collaboration by key stakeholders we can maximize readiness while creating a cohesive system of value-based MSK care worthy of national emulation. The time to act is now.

Brian T Barlow, Andrew J Sheean, Bruce L Gillingham, Enhancing Military Musculoskeletal Readiness: A Proposal for Collaboration, Military Medicine, 2026: usag006. https://doi.org/10.1093/milmed/usag006

m crowell, e florkiewicz, a weart, n reilly, j morris, p mchenry, k rochester, k ford

Abstract accepted for platform presentation at the 2026 American Physical Therapy Association Combined Sections Meeting

Running-related overuse injuries, particularly of the knee, are common in military personnel and impair readiness. While gait retraining is a common intervention, broad implementation is limited by costs, expertise, and time. The purpose of this study was to determine the effectiveness of telehealth gait retraining (THGR) on pain, self-reported function, and footstrike pattern in service members with running-related knee pain.

One hundred eighty active-duty soldiers and cadets aged 18–60 were enrolled. Inclusion criteria included running-related knee pain rated 3–7/10 during or after running and a rearfoot strike pattern.

This single-blind, randomized clinical trial used concealed allocation to assign participants to standard physical therapy (PT) or standard PT plus THGR. Standard PT included interventions aligned with clinical practice guidelines and a return-to-run program without gait retraining cues. THGR participants received auditory and visual feedback via commercially available video coaching software to increase cadence and transition to a non-rearfoot strike (NRFS) pattern. Feedback was delivered weekly during weeks 1–4, and at weeks 6 and 8. Outcomes, including pain via Visual Analog Scale and function via the Single Assessment Numeric Evaluation (SANE), Anterior Knee Pain Scale (AKPS), and University of Wisconsin Running Injury and Recovery Index (UWRI), were assessed at baseline, post-intervention (8 weeks), and a retention follow-up (12 weeks). Footstrike was assessed with 2D sagittal video analysis. Group-by-time interactions were evaluated using 2×3 mixed-model ANOVA for continuous outcomes and chi-square tests for footstrike pattern. Alpha was set at 0.05.

Of the 180 participants, 38 were excluded during baseline screening, and 42 withdrew, leaving 100 in the final analysis (44 THGR, 56 PT). Mean age was 29.9 (8.5) years; 22% were female. Mean symptom duration was 29.8 (28.4) months and weekly running volume was 14.1 (12.9) km. No significant group-by-time interactions were observed for overall pain (F=0.47, p=.61), pain during (F=0.57, p=.54) or after running (F=0.44, p=.61), SANE (F=0.94, p=.38), AKPS (F=0.18, p=.80), or UWRI (F=0.30, p=.70). There were significant time main effects for all variables (p<.001). A group main effect was observed only for pain during running (F=4.19, p=.04). Clinically meaningful improvements were seen in pain and UWRI scores, but not in the AKPS. A significantly greater proportion of THGR participants transitioned to NRFS (65%) compared to standard PT (16%) (χ²=24.12, p<.001).

Telehealth gait retraining combined with standard PT produced similar improvements in pain and function compared to standard PT alone, with both groups showing meaningful clinical improvements in pain and function.

t velasco, n reilly, c hulsopple, k roberts, r boeth, d hoellen, c dickison, d goss, j leggit

Abstract accepted for poster presentation at the 2026 American Physical Therapy Association Combined Sections Meeting

Chronic exertional compartment syndrome (CECS) presents a significant challenge for active-duty service members (ADSMs), with exercise-induced lower-limb pain, weakness, and in extreme cases, disability impacting military readiness. While various treatments have been described, from surgery to structured exercise programs, no consensus on an optimal treatment approach currently exists for CECS2-6. This randomized, placebo-controlled trial’s objective was to determine how different components of a multifaceted, non-surgical treatment program—specifically botulinum toxin A (BoTN-A) injections and structured gait retraining—were associated with improvements in distinct clinical and biomechanical outcomes.

36 ADSMs diagnosed with CECS via Pedowitz’s criteria were randomized to receive BoTN-A (n=20) or saline injections (n=16) into the anterior and lateral lower leg compartments. All participants received structured gait retraining with corrective exercises and running form instruction.

A multiple regression model was developed to analyze the relationship between the interventions and various biomechanical and clinical metrics over the course of rehabilitation. Biomechanical metrics were collected during treadmill running using instrumented shoe insoles (Loadsol, Novel USA, St. Paul, MN)7 to measure cadence, average vertical loading rate (AVLR), and peak ground reaction forces (GRF). Clinical metrics included self-reported current and worst pain, as well as functional scores during running and day-to-day activities via the University of Wisconsin Running Index (UWRI), and Single Assessment Numerical Evaluation (SANE), respectively. All metrics were collected at baseline, 8 weeks, and 3 months.

The analysis revealed that participation in the structured gait retraining program was significantly associated with reduction in self-reported current pain (Est: -1.52, p=0.03) and worst pain (Est: -2.86, p<0.01) at the 3-month follow-up. BoTN-A use was significantly associated with reduced AVLR during running at 3 months (Est: -10.74, p<0.01). While the overall model was significantly associated with improved UWRI scores (p=0.03), no single intervention independently reached significance for this outcome.

A combined, non-surgical approach is beneficial for treating CECS in ADSMs. The components of the multimodal intervention target different aspects of the condition—structured gait retraining was most associated with pain reduction (clinical outcome), while BoTN-A was most associated with improved loading mechanics (a biomechanical outcome). 

t velasco, n reilly, c hulsopple, k roberts, r boeth, d hoellen, c dickison, d goss, j leggit

Abstract accepted for poster presentation at the 2026 American Physical Therapy Association Combined Sections Meeting

Chronic musculoskeletal injuries are the leading cause of disability among the active-duty service member (ADSM) population. Chronic exertional compartment syndrome (CECS) can significantly hinder ADSMs' physical training, especially running, due to exercise-induced pain, numbness, and muscle weakness in the lower limbs. Many affected individuals ultimately require surgical intervention. Further complicating CECS management is that the condition is often overlooked as a cause for reported lower leg symptoms, leading to diagnostic delays of several months to years following initial onset.

A 23-year-old male ADSM presenting with unilateral lower limb CECS as defined by Pedowitz’s criteria was recruited to participate as part of a larger, multi-site randomized controlled trial assessing non-surgical interventions for CECS. His main complaints were pain and symptoms limiting his ability to run for his physical fitness test. Of the 36 participants recruited, he was the only ADSM diagnosed within 6 months of symptom onset. He received structured gait retraining and botulinum toxin A (BoTN-A) injections to the anterior and lateral compartments of his involved leg. Numerical pain rating scale (NPRS), single assessment numeric evaluation (SANE), and University of Wisconsin Running Index (UWRI) were administered at baseline, 8 weeks, 6 months, and 12 months post injection.

This ADSM started with lower SANE scores (indicating worse function) and comparable lower UWRI scores (indicating worse running ability) at baseline compared to the other groups with a symptom onset of more than 7 months. At 8-weeks, 6-, and 12-months follow-ups, this individual continually scored  higher on these measures (SANE and UWRI), indicating greater improvement compared to his cohort. His NPRS score at baseline was also higher than the groups with a longer symptom duration history and improved to 0/10 by 6-months, which remained at the one-year follow-up. Functionally, at 6-months post-injection, the ADSM was able to complete the running portion of his physical fitness test without limitations, pain, or symptoms.

This case demonstrates that timing of diagnosis and seeking early non-surgical treatments for lower limb CECS can be beneficial for improving function and running capability. Clinicians trained to identify the signs and symptoms of CECS early in ADSMs may positively impact their career longevity. However, further research is needed to confirm that early detection in this population can lead to long-term optimal outcomes.

d rhon, n parsons, r greenlee, e metzger, s hole, n hager

Abstract accepted for platform presentation at the 2026 American Physical Therapy Association Combined Sections Meeting

The purpose of this study was to compare the effectiveness of low-level laser therapy (photobiomodulation - PBMT) to sham on graduation rates in military trainees with lower extremity stress fractures. Based on prior reports about the influence of PBMT on bone repair, it was hypothesized that patients receiving PBMT would have significantly better outcomes than patients receiving sham.

Participants were trainees in the Combat Medical Specialist Training Course (CMSTC) in San Antonio, Texas, with an MRI-confirmed diagnosis of metatarsal and/or tibial stress fracture, enrolled between June 2023 and November 2024. All participants received standard of care treatment (activity modification, relative rest, a home exercise program, and physical therapy) and were then randomized to either active or sham PBMT. The PBMT protocol called for three sessions/week up to six weeks (10 to 16 minutes per treatment). Participants in the sham group were prescribed an identical number of sessions, with the device remaining in standby mode. The primary outcome was graduation without delay at four months, and secondary outcomes included the Defense and Veterans Pain Rating Scale (DVPRS) and the Lower Extremity Functional Scale (LEFS), also at four months. Patients with fractures to the 5th metatarsal, anterior tibia, a non-union fracture, pregnant, or with an open wound or tattoo over the area of treatment were excluded.

The mean age (SD) was 23.7 (4.7) years, 54.4% female, and 80.6% in the United States Army. In 46.6% of the cohort, both extremities were affected, with tibia involvement in 69.9% and metatarsal involvement in 30.1%, with severity ranging from grades I to IV. Distribution of severity was similar between groups, with slightly higher proportion of Grade III in the sham group (53.2% vs 30.6%) and slightly higher proportion of Grade II in the active PBMT group (49.0% vs 23.4%). Only 36.9% of all participants graduated without delays (20 from PBMT group; 18 from sham group). There was no statistically significant difference in graduation rates between groups. Furthermore, sex, laterality, and stress fracture location did not predict successful graduation rates. Pain (mean difference[9CI] DVPRS -0.7312 [-2.308, 0.8456]) and function (mean difference[95CI] LEFS 5.8101 [-8.0288, 19.649]) were also not different between groups at 4 months.

Graduation rates, pain intensity, and physical function at four months were not significantly different between military trainees that received low-level laser therapy compared to sham.

m smith, x yuan, v morris, e harris, l lechanski, n parsons, r condon

Abstract accepted for platform presentation at the 2026 American Physical Therapy Association Combined Sections Meeting

The primary objective of this descriptive survey-based study was to characterize the current trigger point dry needling (TDN) practices of clinical providers within the Military Health System (MHS).

The target sample size was 1,000 participants to ensure at least 250 completed surveys including at least 15-20 responses from each specialty and other categories to facilitate subgroup analysis.

This study was approved with exempt determination by the U.S. Army Medical Center of Excellence Office of Research and Human Subject Protections (24-00027e). Active duty and civilian clinical providers (≥ 18 years of age) within the MHS were eligible to complete the survey. Clinical provider types included Physical Therapists (PT), Athletic Trainers (AT), and Physician Assistants (PA). The survey was disseminated through relevant professional networking for convenience sampling. The survey is comprised of 33 questions focused on provider characteristics, training/experience, clinical practice, perceived outcomes, and barriers. Categorical variables will be presented as counts and proportions.

To date, 847 clinicians have accessed the survey. 755 participants (61.3% active duty) completed the entirety of the survey. Most respondents were PTs (43.8%), followed by ATs (22.6%) and PAs (20.7%). 58.3% (n = 440) reported that they currently perform TDN in their practice. Training sources included military (45.6%) or civilian (35.6%) courses, and training by providers from same (15.6%) or different (10.5%) specialties. The body regions treated most often were the shoulder (92.5%), low back/pelvis (87.6%), and head/neck (85.9%). A small provider cohort of 4.6% (n = 24) reported experiencing a major adverse event. The primary barriers to clinical practice were lack of training (20.0%), difficulty obtaining credentialing privileges (18.8%), and insufficient time (15.8%).

TDN is currently employed by a myriad of providers as a cost-effective, low risk and minimally invasive intervention to treat musculoskeletal (MSK) conditions. PTs are most often using this modality to treat the shoulder, low back/pelvis and head/neck within the MHS. Survey results support the need for practice standardization, better access to training, streamlined credentialing processes, and formal clinical practice guidelines to reduce barriers to TDN use in clinical practice, maximize provider confidence, and further optimize safety.

k Rochester, n reilly, c tucker a marshall, g hess, r holloway, d masalleras, k ford, d goss

Abstract accepted for platform presentation at the 2026 American Physical Therapy Association Combined Sections Meeting

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.

M hollander and j hagen

Abstract accepted for platform presentation at SPIE Photonics West 2026

Photobiomodulation Therapy (PBMT) uses visible and near-infrared (600-1100 nm) light to enhance physical and cognitive performance, promote recovery, and support overall wellness. While medical-grade laser-based PBMT is well studied in clinical settings, the recent proliferation of LED-based consumer devices has outpaced the development of validated measurement standards or evidence-based protocols.

This presentation highlights two sequential studies. The first establishes validated methodologies for measuring irradiance and spectral output from PBMT devices, including panels, wearables, and full-body light beds. Using various measurement devices, such as a spectroradiometer, silicon photodiode meter, and thermopile sensor, we documented significant variability in the measured irradiance value, up to 763 mW/cm², depending on the measurement configuration employed. Less concern was found with spectral measurements, where most devices aligned within ±10 nm of manufacturer claims. The vastly variable irradiance findings, however, emphasize the necessity of standardized protocols to ensure accurate dosimetry and device comparisons. In this presentation, we will detail the proposed validation methodology for the three categories of PBMT devices tested. 

The second study applied this validated measurement framework to inform device selection and application of PBMT in a single-blinded, randomized, sham-controlled clinical trial. Military-affiliated participants completed two 4-week blocks (sham and active) using full-body LED PBMT devices. Blood samples were analyzed for inflammatory and stress biomarkers (e.g., TNF-α, IL-6, cytokines), and participants completed numerous validated wellness surveys throughout their time in the study. Comprehensive analyses of heart rate and sleep data collected via wearable devices, subjective survey measures, and objective blood biomarkers will be finalized and presented at the time of the conference.

Together, these studies improve the technical accuracy of PBMT measurements and expand knowledge of its clinical effects, providing a solid foundation for researchers and practitioners to develop evidence-based guidelines and implement LED-based wellness interventions more effectively.

N Hogaboom, t dyson-hudson, n hager, x yuan,

Abstract accepted for poster presentation at the 2026 Association of Academic Physiatrists Annual Meeting

Objectives: Meniscus tears are one of the most common knee injuries and are often associated with pain and functional limitations.1, 2 Acute treatment includes rest, activity modification, pharmacological agents, and physical therapy. Patients refractory to conservative care often progress to corticosteroid injections and, ultimately, surgery if pain and function do not improve. Surgical efficacy is contested3, 4 and has potentially significant short- and longer-term consequences.5 Treatment with orthobiologics has shown promise, but there is no evidence to conclude their long-term effectiveness for meniscus tears. The purpose of this pilot study was to evaluate and compare patient-reported outcomes of knee pain and function up to four years after trephination and injection of either micro-fragmented adipose tissue (MFAT) or normal saline (NS).

Design: Two individuals with knee pain secondary to meniscus tears were recruited. One participant (male, age 38) was injected with 3 mL MFAT with 3 trephinations into the lateral meniscus, and 6 mL into the joint. The other (female, age 44) was injected with 1.5 mL NS with four trephinations into the medial meniscus, and 5 mL into the joint. Pain, function, and quality of life (QOL) outcomes were collected at baseline (treatment); 1, 2, 3, and 6 months; and 1- and 4-years post-injection.

Results: Both individuals reported improvements in four-year outcomes, including PROMIS Mobility v2.06 (MFAT: 8%, NS: 21.3%); Numerical Rating Scale score (MFAT: 80%, NS: 100%); PROMIS Global Physical Health v2.07 (MFAT: 11.8%; NS: 5.8%); and scores of Knee Injury and Osteoarthritis Outcome Score (KOOS)8 Symptom (MFAT: 27.3%; NS: 30.8%), Pain (MFAT: 62.5%; NS: 83.3% NS), Function (MFAT: 72.7%; NS: 100%), Sports/Recreation (MFAT: 69.2%; NS: 57.1%), and QOL subscales (MFAT: 61.5%; NS: 57.1%). Both treatments were well-tolerated with no reported adverse events.

Conclusions: While these results are promising, a larger, randomized controlled trial is needed to show efficacy for either treatment.

h diaz, j smith, a hurvitz, m noce, j mosavi

Abstract won the 2025 Founders Award for its rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRDUCTION: Corticosteroid injections (CSI) are commonly used for short-term pain relief in patients with glenohumeral osteoarthritis (GHOA), but they do not modify disease progression and may contribute to tendon degeneration or increase complications associated with future surgery. Platelet-rich plasma (PRP) has emerged as a potential alternative without the deleterious effects of corticosteroid though its efficacy in GHOA remains unclear. This study compares the effectiveness of leukocyte-poor PRP (LP-PRP) and CSI in pain reduction and functional improvement in young, active patients with GHOA.

METHODS: This prospective, randomized, single-blind, multi-center study enrolled 50 patients diagnosed with mild to moderate GHOA.  Patients were divided into three treatment groups: (1) LP-PRP only (n=17), (2) CSI only (n=17), and (3) CSI with the option to transition to LP-PRP if no improvement in pain at 6 weeks post injection (n=16, with 6 crossing over). Pain was assessed using the Visual Analog Scale (VAS) at baseline, 3, 6, 12, 26, and 52 weeks. Generalized additive models (GAMs), as well as the plotting of observed pain trends, were used to evaluate pain trajectories over time.

RESULTS: Pain improved most significantly within the first three months in both CSI and PRP groups. CSI-treated patients reached their lowest pain levels at three months, followed by a gradual return toward baseline by 12 months. However, PRP-treated patients experienced a more sustained reduction, reaching their lowest pain levels at six months before returning to near pre-treatment levels by 12 months. Patients who transitioned from CSI to PRP showed the greatest overall pain reduction. While these observed trends suggested potential effects that should be studied further, no statistically significant differences were detected between treatment groups.

CONCLUSION: LP-PRP and CSI provided short-term pain relief in GHOA, though PRP exhibited a possible longer-lasting effect. Sequential treatment with CSI followed by PRP showed the most pronounced improvement, suggesting that cumulative or a series of injections may contribute to improved outcomes. Larger studies are needed to further evaluate the long-term efficacy of these treatments in active populations.

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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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.