k rochester, n reilly, c tucker, a marshall, g hess, b holloway, d masalleras k ford, d goss

Abstract accepted for podium presentation at the 2026 Naval Medical Center Camp Lejeune’s Annual Research Symposium

Purpose/Hypothesis: 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 Soldiers with different BMIs. We hypothesized that Soldiers with greater BMI would run with biomechanics related to increased risk of RRIs.

Materials and Methods: Soldiers completed an IRB approved consent form and were given a numbered race bib to affix to their chests with with tape . Soldiers ran 900 meters through a 12-camera (200Hz) markerless motion capture system three separate times. Data were processed utilizing machine learning algorithms to track the running motion and create 3D pose estimations. Soldiers were compared between BMI groups calculated from self-reported height and weight (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.

Conclusions: We were able to identify differences in running biomechanics between 3 BMI groups using markerless motion capture. Running with decreased sagittal plane motion at the hip and knee and increased adduction at the hip and knee may predispose Soldiers with greater BMI for RRI. Increased knee adduction has led to increased risk for RRI in previous studies (Venable, 2022).

Clinical Relevance: We observed differences in running biomechanics between Soldiers with normal, overweight, and obese BMI measures. This information may inform physical therapists treating Soldiers and civilian runners of varying BMI.

J Dobrich, R Frenette, M Feldman, F Say, L Gillette, Z Colburn, J Dannenbaum, M Bedrin

Abstract accepted for poster presentation at Madigan Research Day 2026

Background: Anterior cruciate ligament (ACL) injuries are common orthopedic conditions, with revision ACL (RACL) surgeries often required due to graft failure or reinjury. Emerging evidence suggests that the synovial fluid microbiome may play a role in joint health and recovery, yet its composition in ACL and RACL patients remains poorly understood.

Methods: This study analyzed demographic data and synovial fluid microbiome composition from 18 patients enrolled in an orthopedic biorepository. Patients were divided into two groups: primary ACL repair (n=13) and RACL repair (n=5). Synovial fluid samples were collected during surgery, and microbial DNA was extracted for 16S rRNA gene sequencing. Bioinformatics analysis was performed using QIIME 2, and statistical comparisons of microbial diversity and differential abundance were conducted.

Results: Demographic characteristics, including age, sex, race, and ethnicity, showed no significant differences between the ACL and RACL groups. Microbiome diversity metrics (Chao1, Shannon, Inverse Simpson, and Fisher's alpha) revealed no statistically significant differences between groups. However, differential abundance analysis identified several microbial taxa with significantly higher relative abundances in RACL patients, including Sediminibacterium, Bradyrhizobium, and Pseudomonas species. Conversely, taxa such as Corynebacterium kroppenstedtii and Acinetobacter proteolyticus were more abundant in ACL patients.

Conclusion: This study highlights distinct shifts in the synovial fluid microbiome composition between primary and revision ACL surgery patients. These findings provide insights into potential microbial contributions to joint health and recovery, paving the way for future research on microbiome-targeted interventions in orthopedic care.

M Feldman, J Dobrich, R Frenette, F Say, L Gillette, Z Colburn, J Dannenbaum, M Bedrin

Abstract accepted for poster presentation at Madigan Research Day 2026

Background: Intra-articular injections are frequently used in the management of joint conditions prior to total knee arthroplasty (TKA). However, their impact on systemic inflammatory and immunological biomarkers remains unclear. This study aimed to evaluate plasma cytokine and chemokine profiles in TKA patients with varying histories of joint injections.

Methods: Peripheral blood samples were collected from 41 TKA patients categorized into three groups based on injection history: no prior injection (None, n=10), injection within six months (<6 mo, n=14), and injection more than six months prior to surgery (>6 mo, n=17). Plasma was isolated and analyzed using the Bio-Plex Pro Human Immunotherapy Panel, which quantifies 20 cytokines and chemokines. Biomarkers with more than 10% missing or out-of-range (OOR) values were excluded. Statistical comparisons of demographic characteristics and biomarker concentrations were performed using ANOVA, Kruskal-Wallis tests, and two-way ANOVA controlling for sex. False discovery rate (FDR) adjustments were applied to account for multiple comparisons.

Results: Demographic analysis revealed significant differences in sex distribution across groups (Fisher's exact test, p=0.0017), while age, race, and ethnicity showed no significant differences. Of the 20 biomarkers analyzed, seven were excluded due to high percentages of missing or OOR values. Statistical analysis of the remaining biomarkers revealed no significant differences across groups after FDR adjustment. However, several biomarkers, including IL-2, IL-18, and MCP-1, approached significance across multiple tests.

Conclusion: This study provides insights into the potential effects of joint injection history on systemic inflammatory biomarker profiles in TKA patients. While no significant differences were observed, trends in specific biomarkers suggest avenues for further investigation into the immunological impact of intra-articular injections.

B Kowalski, M Deegan, H Johnson, F Say, L Gillette, Z Colburn, J Dannenbaum, M Bedrin

Abstract accepted for poster presentation at Madigan Research Day 2026

Background: Cytokines and chemokines play critical roles in inflammation and tissue repair, yet their plasma concentrations in patients undergoing primary anterior cruciate ligament (ACL) repair and revision ACL (RACL) repair remain poorly understood. This pilot study aimed to compare plasma biomarker profiles between ACL and RACL patients to identify potential differences in inflammatory and immunological responses.

Methods: Peripheral blood samples were collected from 21 patients (ACL group: n=15; RACL group: n=6) at the time of surgery. Plasma was isolated and analyzed using the Bio-Plex Pro Human Immunotherapy Panel, a multiplex immunoassay measuring 20 cytokines and chemokines. Biomarker concentrations were reported in pg/mL, and values outside the detection range were flagged and processed. Statistical comparisons of demographic characteristics and biomarker concentrations were performed using t-tests, Wilcoxon rank-sum tests, and ANOVA controlling for sex. False discovery rate (FDR) adjustments were applied to account for multiple comparisons

Results: No significant differences in demographic characteristics, including age, sex, race, and ethnicity, were observed between the ACL and RACL groups. Of the 20 biomarkers analyzed, six were excluded due to missing or out-of-range values. Statistical analysis of the remaining biomarkers revealed no significant differences between the groups after FDR adjustment. However, several biomarkers, including CCL3, CCL4, and RANTES, approached significance across multiple tests, suggesting potential trends in inflammatory marker expression.

Conclusion: This study provides the novel comparison of plasma cytokine and chemokine profiles in ACL and RACL patients, highlighting potential trends in biomarker expression that warrant further investigation. These findings contribute to the understanding of inflammatory processes in primary and revision ACL repair and may inform future research on targeted therapeutic strategies.

C Gerber, M Feldman, R Frenette, F Say, L Gilette, Z Colburn, J Dannenbaum, M Bedrin

Abstract accepted for poster presentation at Madigan Research Day 2026

Background: Intra-articular injections are commonly administered prior to total knee arthroplasty (TKA) to manage pain and inflammation, yet their impact on the synovial fluid microbiome remains unclear. We aimed to investigate the influence of pre-operative intra-articular injections on the synovial fluid microbiome composition in TKA patients.

Methods: Twenty-six TKA patients were divided into two cohorts: those who received an intra-articular injection within six months prior to surgery (injection group, n=13) and those who did not (non-injection group, n=13). Synovial fluid samples were collected during surgery, and microbial DNA was extracted for 16S rRNA gene sequencing targeting the V3-V4 hypervariable regions. Bioinformatics analysis was performed using QIIME 2, and microbial diversity metrics and differential abundance of taxa were compared.

Results: Demographic comparisons revealed significant differences in sex distribution and beneficiary category between the injection and non-injection groups, while age, race, and ethnicity showed no significant differences. Alpha diversity metrics, including Chao1, Shannon, Inverse Simpson, and Fisher's alpha, demonstrated no statistically significant differences between the two groups. However, differential abundance analysis identified several microbial taxa with significantly altered relative abundances between the injection and non-injection groups. Specifically, 30 taxa were enriched in the injection group, while 16 taxa were more abundant in the non-injection group.

Conclusion: We identified specific differences in the synovial fluid microbiome associated with pre-operative intra-articular injections in TKA patients. These findings provide insights into the potential microbiome-related effects of intra-articular injections, paving the way for further research on their implications for joint health and surgical outcomes.

M Deegan, B Kowalski, R Frenette, F say, L Gillette, Z Colburn, J Dannenbaum, M Bedrin

Abstract accepted for poster presentation at Madigan Research Day 2026

Background: The synovial fluid microbiome is becoming increasingly recognized for its role in joint health and disease, yet how its composition differs relates to different joint conditions such as in patients undergoing primary anterior cruciate ligament (ACL) repair and total knee arthroplasty (TKA) remains poorly characterized. We aimed to compare synovial fluid microbiome profiles between these two distinct patient groups.

Methods: Synovial fluid samples were collected from 13 ACL patients and 13 TKA patients during surgery. Microbial DNA was extracted and analyzed using 16S rRNA gene sequencing targeting the V3-V4 hypervariable regions. Bioinformatics analysis was performed using QIIME 2, and microbial diversity metrics were calculated. Statistical comparisons of demographic attributes, alpha diversity indices, and differential abundance of microbial taxa were conducted.

Results: Significant demographic differences were observed between the groups, with ACL patients being younger (median age: 25 years) and predominantly male, while TKA patients were older (median age: 67 years) and exclusively female. Alpha diversity metrics revealed significantly higher microbial richness and evenness in TKA patients compared to ACL patients, as evidenced by Chao1, Shannon, and Inverse Simpson indices. Differential abundance analysis identified several taxa enriched in TKA patients, including Burkholderia, Aquabacterium, and Moraxella cinereus, while taxa such as Acinetobacter proteolyticus and Pseudomonas alloputida were more abundant in ACL patients.

Conclusion: Our results reveal distinct synovial fluid microbiome profiles between ACL and TKA patients, with significant differences in microbial diversity and taxa abundance. These findings provide insights into the potential role of the microbiome in joint health and recovery, paving the way for future research on microbiome-targeted therapies in orthopaedic care.

E metzger, n hughes, r rossi, e harris

Abstract accepted for podium presentation at the 2026 Special Operations Medical Association Scientific Assembly

Special Operations Forces (SOF) are nearly always in a state of recovery and in need of noninvasive therapies to address this taxing workload. Photobiomodulation therapy (PBMT) is a noninvasive treatment where low-level laser is applied to the body to enhance healing, recovery, and performance. Army Tactical Human Optimization Rapid Rehabilitation and Reconditioning (THOR3) provides a consistent avenue for implementation of PBMT as a modality. Studies in athletes have shown performance and recovery benefits with pre-and post-workout focal application of PBMT. While there is less evidence on the potential cognitive/behavioral effects after application of PBMT, self-reported fatigue has also been found to be significantly lower in groups with PBMT. Further, PBMT research in healthy elite Warfighters is limited. PBMT may be a promising tool for enhancing physical performance by accelerating musculoskeletal and psychological recovery in the SOF population. We aim to study the physiologic and behavioral effects of PBMT application post-exercise on performance in SOF Operators.

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.