Fellin c, steiner r, buchen j, woodle s, yuan x, anders j,

jariwala s

Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium

The most severe case of peripheral nerve injury (PNI) involves complete transection of the nerve. One therapeutic approach uses nerve guidance conduits (NGCs) to facilitate nerve regeneration. Recently, three-dimensional (3D) bioprinting has been adopted for the fabrication of biomimetic conduits. However, many of these NGC therapies fail to achieve full reinnervation making it necessary to employ a combinatorial approach that incorporates treatments in conjunction with 3D printed conduits. Photobiomodulation Therapy (PBMT) utilizes electromagnetic energy to achieve beneficial therapeutic outcomes. Most notably, exposure to near-infrared light (700 - 1100 nm) has been shown to reduce inflammation and improve neural regeneration. Herein, we investigate whether the use of a novel 3D printed NGC in conjunction with PBMT (980 nm) will improve nerve regeneration when used as a combinatorial approach in a rodent sciatic nerve transection model.

The tissue of conduit-repaired rodents displayed no sign of foreign-body reaction, inflammation, or macrophage infiltration. The conduits remained sutured to the nerve stumps and displayed a high degree of ECM integration and neovascularization. Histological analysis indicates new nerve tissue present inside the conduit lumen with typical axon and vasculature anatomical features. Rodents treated with PBMT displayed significantly more regenerating nerve tissue within the conduit.

The results of this study demonstrate successful implantation of the DLP 3D printed NGC with no observable foreign-body reaction, a high degree of ECM integration, and neovascularization. Nerve regeneration was detected within the conduit and improved with the addition of PBMT. These findings support the use of PBMT as a combinatorial approach to conduit-based peripheral nerve repair.

Shaw k, wido d, smith m, miller m

Abstract accepted at American Association of Neuromuscular and Electrodiagnostic Medicine 2024

Electrodiagnostic studies and diagnostic ultrasound evaluation are vital tools for the management of CTS. Aberrant anatomy is an important consideration for surgical disposition. Berrettini anastomosis is an interneural communication between common palmar digital sensory branches from the median and ulnar nerves. Here, we report a unique case of a patient with moderate carpal tunnel syndrome and concomitant Berrettini anastomosis, highlighting preoperative value of ultrasound in the EDX clinic in avoidance of iatrogenic injury. 

Ultrasound is an important adjunct to EDX in the preoperative stage of carpal tunnel syndrome management. Identification of aberrant anatomy via ultrasound has the potential to minimize complications from carpal tunnel release (CTR). In this case, a Berrettini anastamosis was identified and rather than proceed with ultrasound-guided CTR, the patient was referred to Orthopedics for open CTR.

Rhon d, George s, parsons n, fritz j

Abstract accepted at the IASP 2024 World Congres on Pain.

Patients beliefs about low back pain can affect perceived harms and benefits of various treatment options. This can subsequently influence the patient’s level of engagement with interventions and the treatment effectiveness. When receiving care, a greater emphasis on the biomedical model could lead to surgery being seen as one of the only acceptable interventions. Similarly, from a biomedical perspective, exercise could be seen as potentially exacerbating rather than helping low back pain. In contrast, patients who don’t perceive surgery to be an effective solution or understand that exercise can help improve their symptoms, may engage at a higher level with evidence-based treatments. Therefore, the aim of this study was to assess the influence of healthy versus maladaptive beliefs about surgery and exercise as interventions for low back pain. Specifically, we aimed to assess the relationship between these beliefs and self-reported pain interference and physical function outcomes.

Maladaptive beliefs about treatment have the potential to adversely influence pain and physical function outcomes in the short term out to six months. Patients receiving care for low back pain who believed that surgery would be beneficial or that exercise would be harmful improved significantly less than patients who felt otherwise. The ability to better understand and address patient beliefs about treatment effectiveness may present an opportunity to improve engagement with interventions and subsequently treatment outcomes.

Rhon d, George s, parsons n, fritz j

Abstract accepted at the IASP 2024 World Congres on Pain.

Patients beliefs about low back pain can affect perceived harms and benefits of various treatment options. This can subsequently influence the patient’s level of engagement with interventions and the treatment effectiveness. When receiving care, a greater emphasis on the biomedical model could lead to surgery being seen as one of the only acceptable interventions. Similarly, from a biomedical perspective, exercise could be seen as potentially exacerbating rather than helping low back pain. In contrast, patients who don’t perceive surgery to be an effective solution or understand that exercise can help improve their symptoms, may engage at a higher level with evidence-based treatments. Therefore, the aim of this study was to assess the influence of healthy versus maladaptive beliefs about surgery and exercise as interventions for low back pain. Specifically, we aimed to assess the relationship between these beliefs and self-reported pain interference and physical function outcomes.

Maladaptive beliefs about treatment have the potential to adversely influence pain and physical function outcomes in the short term out to six months. Patients receiving care for low back pain who believed that surgery would be beneficial or that exercise would be harmful improved significantly less than patients who felt otherwise. The ability to better understand and address patient beliefs about treatment effectiveness may present an opportunity to improve engagement with interventions and subsequently treatment outcomes.

schermerhorn j, rich e, kazman j, clifton d, nelson a

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Non-combat musculoskeletal (MSK) disorders are a major cause of morbidity in the U.S. Army. Physical fitness tests are required for training and readiness but they may be accompanied by injury risks. The Army recently transitioned from the Army Physical Fitness Test (APFT) to the Army Combat Fitness Test (ACFT). We hypothesize that this transition, and associated changes in individual and group training regimens, are associated with increased MSK diagnoses.

We conducted a retrospective review of recently enlisted active-duty Service Members from 2016 to 2022 and analyzed the incidence of MSK diagnoses within the first six months of military service.  The three cohorts were control APFT (2016–2019), COVID (2020–2021), and ACFT (April 2022–October 2022). All cohorts began in April. Survival analyses were used to compare ACFT and COVID cohorts with the control APFT.

Among new enlistees, risk for MSK conditions has fluctuated over years, likely in response to the introduction of the ACFT in April 2022 and to COVID lockdowns. Consistent with much prior research, women had much higher rates of MSK conditions than men, which might mask trends over time (e.g., due to a ceiling effect). Continued monitoring of MSK trends over time and practices around the ACFT is necessary to maximize force readiness and minimize overall MSK disorder burden.

cohen s, li s, lester d, clark w, mcgee m, boggs j

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Chronic low back pain (CLBP), including degenerative spine conditions such as spondylosis, is associated with debilitating pain and functional impairments and is a significant problem for US Service Members and Veterans. Percutaneous (60-day) peripheral nerve stimulation (PNS) is an opioid-free, non-destructive treatment that is commercially available, in use in the Military Health System, and has resulted in meaningful pain relief and functional improvement across various conditions. A large prospective multicenter trial previously presented at MHSRS revealed significant and sustained long-term relief of CLBP. The present analysis explores real-world outcomes for patients with a diagnosis of spondylosis, including a subset with reported ICD10 codes M47.816/M47.817 (lumbar/lumbosacral spondylosis without myelopathy or radiculopathy), to determine if real-world outcomes are consistent with the prospective study.

Data were retrospectively reviewed from a real-world database of patients who: previously received 60-day PNS targeting the lumbar medial branch nerve(s), were reported as having lumbar spondylosis without neuropathic symptoms, opted to provide anonymized data, and provided baseline and end of treatment (EOT) outcomes. A subset was analyzed in those with confirmed ICD-10 diagnosis codes M47.816 or M47.817. Responders were defined as patients who reported ≥50% pain relief and/or clinically meaningful improvement (≥1) in physical function as measured by the Patient Global Impression of Change. Safety was not analyzed in this retrospective review

Consistent with prospective trials, PNS targeting the lumbar medial branches produced significant improvements in real world outcomes of pain and physical function at EOT in the majority of patients with spondylosis. A follow-on DoD PRMRP-funded randomized controlled trial (the RESET Study) that compares 60- day PNS to standard interventional management for CLBP recently completed enrollment and primary endpoint results are expected in 2025. 60-day percutaneous PNS treatment is an opioid-free, non-destructive treatment option available for U.S. Service Members and Veterans with spondylosis without myelopathy or radiculopathy.

galvin j, johnson c, say f, free k, eichinger j, patterson b, nepola j, hogue j, dalgard c, colburn z

Abstract accepted at The Society of Military Orthopedic Surgeons 2024 Annual Meeting

Glenoid dysplasia is a rare pathology characterized by failure of development of the posterior glenoid, resulting in severe deformity and alteration of shoulder mechanics. It is largely asymptomatic until approximately 25 to 45 years of age. When patients develop pain, they typically already have severe posterior cartilage wear and early-onset osteoarthritis. Therefore, early detection of glenoid dysplasia may offer an opportunity to intervene in adolescence or counsel patients on their condition so they can modify their activities. The purpose of this study was to identify genetic variants associated with the diagnosis of severe glenoid dysplasia.

Three male patients (mean age: 40.3 yrs, range: 38-43) with severe glenoid dysplasia who underwent blood draw at the time of operative treatment were analyzed. High molecular weight genomic DNA was isolated from the stabilized whole blood before PCR-free sequencing libraries were generated with sufficient yield for downstream sequencing. Whole genome sequencing (WGS) was performed on all 3 patients with genomic data passing quality assessment (QA) after alignment and variant calling (mean coverage >30x, alignment >97%, percent bases 20x >92%). For variant priorization and interpretation, we utilized a phenotype-aware workflow, Genomizer, with the gene ontology HP:0006633 and the parent ontology of “abnormality of the glenoid fossa.” Additionally, we interpreted variants from genes within the American College of Medical Genetics and Genomics (ACMG) v3.2 list, to potentially report actionable secondary findings.

HOXA9,c.715G>A:p.(Val239Met) was identified as a candidate genetic variant in 1 of 3 patients with severe glenoid dysplasia. Prior evidence has implicated the HOX gene in the development of the inferior glenoid ossification center. This information may lead to future precision medicine approaches for early diagnosis and novel treatments. Future larger studies are needed to confirm these findings.

Yuan x, isaacson b

Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium

The MHS transitioned to the ICD10 coding scheme in October 2015 and began the rollout of a new electronic health record (EHR) system, MHS GENESIS, in October 2017. Both changes may have affected the observed prevalence and healthcare utilization associated with musculoskeletal injuries (MSKIs) in Service members. The purpose of this study was to 1) determine the effect of the ICD10 transition on the prevalence of select MSKI conditions and 2) describe MSKI-related healthcare utilization at military treatment facilities (MTFs) during the transition to GENESIS.

We calculated monthly prevalence rates for six diagnostic groupings of MSKIs from October 2011 to February 2020. To determine if the transition to ICD10 influenced prevalence rates, we performed an interrupted time series analysis (ITSA), using the ICD10 transition date (1 October 2015) as the interruption point. To assess trends in direct and private sector care encounters during the GENESIS transition, we calculated monthly MSKI-related encounters at four MTFs from 1 November 2015 through 30 September 2021.

Differences in prevalence of MSKIs could be due to changes in the amount and/or specificity of available codes in ICD10. Those involved in MSKI surveillance should exercise caution when evaluating periods that span the ICD10 transition. For analyses that span such a transition, ITSA is a viable approach to capturing MSKI rates. Changes in healthcare utilization patterns in two of four MTFs during their adoption of GENESIS suggest MSKI care may have shifted from direct to private sector care during this period.

goss d, gaunaurd i, rochester k, helton m, marshall a, reilly n, melton c, gailey r

Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium

Musculoskeletal injuries (MSI) are very common in the military population and even more common with very active and elite paratroopers in the 82nd Airborne Division.  Potter et al. published a one-year prospective cohort study in 2002 in Military Medicine outlining these injuries.  They followed 1,965 paratroopers in from Fort Bragg in 1996. These soldiers suffered 508 overuse injuries (including 38 stress fractures), 1,415 traumatic injuries (including 100 fractures), and 101 unclassified injuries. Injury rates were 6.8% per soldier per month for traumatic injury and 2.4% for overuse injury (totaling 1.2 injuries per soldier per year). Injuries resulted in 22,041 limited duty days, averaging 11 days per injury and 13 days per soldier (4.5% of total workdays). Fractures and stress fractures/reactions produced the most days lost per case. Most of these injuries resulted from military specific activities.

As part of a prospective injury prediction protocol involving knee sensors analyzing single leg stance and a side shuffle task, our Musculoskeletal Injury Rehabilitation Research for Optimal Readiness (MIRROR) team enrolled and screened 1183 soldiers from the 82nd Airborne Division at Fort Bragg/Liberty, NC from fall 2022 to fall 2023 with 6- month and 12-month MSI incidence evaluated in the electronic medical record (AHLTA and Genesis).

These results highlight the types of injuries an active group of soldiers from the 82nd Airborne Division are experiencing and can help to guide prevention and treatment strategies going forward.

foster k, wang-proce s, weber m, brizzolara k, yuan x, boeth r, rhon d

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Exercise is a treatment recommended in clinical practice guidelines for low back pain (LBP). The primary purpose was to determine the impact of receiving therapeutic exercise (TE) for the management of LBP on time-to occurrence of subsequent lower extremity (LE) injury within 1 year, in beneficiaries of the Military Health System (MHS). The secondary purpose was to examine the dosing impact (number of TE sessions) on time-to-occurrence of subsequent LE injury in beneficiaries who received TE.

Following LBP diagnosis, individuals wh did not recieve TE had an increased rish of subsequent LE injury in the year following the episode of LBP. Further, in individuals who did receive TE, the risk of subsequent LE injury significantly decreased with each additional session. The results of the study highlight the potential downstream impact and health, implications of LBP, as well as information to guide to treatment and return to duty decisions after LBP.

bradley m, sheean a

Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium

Musculoskeletal injuries (MSKI) remain the largest source of disability, readiness impairment, non-deployable status, and separation within the US Military. Although MSKI are of such magnitude, severity, and cost, efforts to uniformly collect and evaluate outcomes following injury and treatment are lacking due to decentralized datasets and the migratory nature of military service members (SM). The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) is addressing this issue by establishing a DoD-wide enterprise system for the reliable collection of validated health outcome measures related to MSKI that cause the greatest impact on readiness, disability, and well-being.

MOTION is an ongoing collection of patient-reported outcomes (PROs) and clinical provider assessments of patients who are receiving treatment of MSKI. The target population is active duty SM, retirees, and beneficiaries who receive various orthopaedic and rehabilitative treatment interventions on upper extremity, lower extremity, or spine MSKI. All patients are enrolled at the time of their initial presentation to the orthopaedic or allied health clinic. PROs are collected at the following time points: pre-operative visit, 6-weeks post-op, 6-months, 12 months, 2, 5, 10, 15, and 20 years.

MOTION will develop, conduct, and disseminate original and innovative military relevant clinical research focusing on outcomes and reducing time away from duty following MSKI. This research will result in the development and improvement of evidence-based clinical practice guidelines to improve military health and readiness, mitigate long-term physical detriments following injury, promote military career longevity, and improve post-military service quality of life. MOTION’s revolutionized MSKI care system will place the MHS at the forefront of MSKI care advancement and will result in a centralized, enterprise-wide MSKI care system for improving clinical best practices that is based in evidence, informed by data, and geared towards individualized therapeutic interventions.eatment.

Velasco t, reilly n, hulsopple c, roberts k, wise s, goss d, leggit, j

Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium

Chronic exertional compartment syndrome (CECS) is a debilitating condition for runners, causing intense pain, paresthesia, and weakness in the lower limb muscles. This condition often affects active-duty service members (ADSMs) who engage in regular running and vigorous physical training. Although treatments like botulinum toxin A (BoTN-A) injections, structured running gait retraining, and fasciotomy exist, no single best approach exists, and outcomes may vary. This case study examines the running biomechanics and efficacy of a multimodal treatment approach for CECS in an ADSM.

A 27-year-old male ADSM presented with bilateral anterior and lateral CECS as defined by Pedowitz’s criteria. Baseline running assessments were performed utilizing instrumented pressure insoles (LoadSol, Novel USA, St. Paul, MN) to ascertain running mechanics, including cadence, loading rates, and peak ground reaction forces (GRF) incurred during running. The patient also reported subjective pain at cessation of running and functional scores via the University of Wisconsin Running Index (UWRI). The patient received BoTN-A injections to the 4 compartments, and completed a supervised gait retraining program as a non-surgical intervention. Running assessments and clinical outcomes were obtained at 6-weeks, 3, 6 and 12-months post-injection. The patient elected to undergo a bilateral fasciotomy following the 6-month visit.

This case study demonstrates how both surgical and non-surgical methods can influence the treatment of CECS and impact running biomechanics for an ADSM. In this case, non-surgical techniques resulted in more significant enhancements in running mechanics and clinical outcome scores. However, further data is required to ascertain the reliability of these results and to develop more efficacious treatment strategies for CECS

Rhon d, arden n, motte s, fallowfield j, fisher b, bullock g

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Musculoskeletal injuries threaten military readiness. The ability to aggregate data and make valid comparisons across settings, military branches, and nations is only possible when data can be harmonized. The purpose was to reach international consensus on the minimum core data elements that should be collected and reported when conducting injury surveillance in military settings.

Steering committee members were selected to balance expertise across clinical and research backgrounds, country, and military branches, along with policy, implementation, or clinical/scientific investigation related to musculoskeletal injuries in military settings (n=45). Pertinent parties were engaged to improve the overall question, understand research implications, and facilitate knowledge translations. A synchronous mixed pertinent party meeting (n=62) was performed to explore level of agreement by experts who were identified through the closeness continuum. The moderator presented each statement with discussion prior to voting. Participants voted anonymously. Each statement was scored on a scale of 0-10, with 0 representing no importance and 10 representing maximum importance. Comments could be submitted to facilitate further discussion and elaboration. A majority was needed for inclusion. Dissenting opinions were discussed and included in the final consensus document.

33 minimal data elements were recommended when conducting surveillance and reporting of injuries. This core checklist can be leveraged by clinicians, researchers and stakeholders when comparing and harmonizing data across studies, military service branches, and countries.

Colahan c, pav v, yuan x, isaacson b, wagner l, hando b

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Musculoskeletal injuries (MSKIs) are highly prevalent and costly conditions among active duty Service members (ADSMs). Female Service members sustain MSKIs at higher rates than males. However, lack of female-specific MSKI research in the US Military has limited Department of Defense leaders from assessing and addressing their burden. The purposes of this study were to report the incidence, prevalence, and types of MSKIs sustained by female ADSMs across four Services in direct care (DC) and private sector care (PC) settings from fiscal years (FYs) 2016-21, and to quantify and describe MSKI-related healthcare utilization and private sector costs in females over the same period.

This retrospective, longitudinal population study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence/incidence rates for Head/Neck, Upper Extremity (UE), Spine, and Lower Extremity (LE) MSKIs in female ADSMs, associated healthcare utilization, and PC costs were derived by querying electronic health records from the Military Health System (MHS) Data Repository from FY16-21. Utilization associated with MSKIs among females for each Body Region in DC and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs in Service women were captured for each year, Service, Body Region, and setting.

This is the first population-level assessment of MSKI prevalence, incidence rates, healthcare utilization, and PC costs over a 6-year period for Service women in the MHS. Given the critical role of Service women in the military, MHS leaders, researchers, and public health officials should explore the underlying causes of these disparities in MSKI rates between the sexes, by expanding research efforts to all Services and military settings.

smith m, hogaboom n, dellanno r, st laurent m, yuan x,

nordstrom m

Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium

Chronic neck pain impacts active duty Service Members (ADSMs) across all occupational specialties. Reduction of cervical lordosis in forward head posture (FHP) can lead to muscular imbalances, degenerative spinal changes, and increased neck pain. This study investigated the safety and efficacy of a novel, non-invasive therapy collar to improve FHP and neck pain among ADSMs.

Recent literature suggests current treatment strategies for neck pain may not be as effective for the active duty population, given their occupational, training, and external load carriage requirements. Therefore, evaluating the effects of a wearable, take-home device for neck pain due to FHP is highly relevant to ADSMs. Preliminary results suggest donning a non-invasive therapy collar for 6 weeks can yield pain reduction and postural improvement compared to conventional treatment.

blasini r, stewart e, smith m, kasuske a, bradley m, yuan x

Abstract accepted for oral presentation at the 2024 Military Health System Research Symposium

Musculoskeletal injuries (MSKI) affect 800,000 service members annually. Significant need exists to investigate strategies that impact the health, performance, and readiness of service members with MSKI. Platelet-rich plasma (PRP) offers a non-pharmacologic, minimally invasive approach to expedite tissue healing, recovery, and return to duty (RTD). Little is known on PRP outcomes in the military. The purpose of this practice improvement project is to evaluate outcomes following PRP injections at the Walter Reed National Military Medical Center Physical Medicine and Rehabilitation Clinic.

Greenlee t, george s, pickens b, rhon d

Abstract accepted for oral presentation at the Symposium of the International Musculoskeletal, Mental, and Social Health (I-MESH) Consortium

A recent trial in the Military Health System (MHS) found risk-stratified care not superior to usual care for low back pain (LBP) for a primary outcome of self-reported disability. Because risk-stratified care follows a biopsychosocial framework and aims to target maladaptive beliefs, the question remains whether the intervention adequately addresses pain attitudes and maladaptive beliefs. We aimed to compare improvements in (1) pain attitudes related to harm and (2) pain knowledge and beliefs in patients with LBP based on assigned intervention (riskstratified versus usual care).

Risk-stratified care significantly improved maladaptive attitudes and beliefs about pain at six weeks compared to usual care. An attenuated treatment effect, regardless of treatment, was seen in high or medium versus low-risk patients. Although these changes did not translate to better clinical outcomes in the clinical trial, they reflect short-term success of risk-stratified care in decreasing maladaptive attitudes and beliefs about pain.

Rhon d, Arden n, motte s, fallowfield j, fisher b, bullock g

Abstract accepted for oral presentation at the 2024 ICMM World Congress on Military Medicine.

Musculoskeletal injuries are a significant threat to military readiness; sustained by over half of individuals in many military units each year. These injuries threaten mission capabilities through reduced workforce. Mitigating injury risk requires accurate representation of the problem and adequate data to properly inform decisions. Additionally, the ability to aggregate data and make valid comparisons across settings, military branches, populations and nations is only possible when the same data elements exist. The purpose of this project was to reach international consensus on the minimum core data elements that should be collected and reported when conducting musculoskeletal injury surveillance in military settings.

Consensus was reached for two data principles and 33 minimal data elements. These elements include demographics, health behaviors, service branch, health history, exposure, and injury characteristics. This core checklist can be leveraged by clinicians, researchers and stakeholders working in military settings when comparing and harmonizing data across studies, military service branches, and countries. Ultimately, this will lead to better synthesis of evidence-based practice and ability to generate a greater number of useful prognostic models in the future.

rhon d, Drysdale l, radcliffe c, newman p

Stress fractures are common in military personnel, with training that often leads to overload and repetitive bone stress. These injuries limit duty, affect military readiness, and can end a military career. Injury mitigation is a high priority for military leadership and health, but risk profiles for stress fractures have not been fully explored. Many studies have evaluated risk factors, but meta-analyses of risk with aggregated study data are few. The purpose of this review was to conduct a systematic review of the literature to identify risk factors for stress fracture in military populations, and through meta-analysis, calculate aggregate risk profiles.

The search assessed studies published between January 1995 and September 2023 in PUBMed and CINAHL. Any study assessing risk factors for any type of stress fracture in a military population was considered, as long as an English translation was available. We excluded studies predicting disability, return to duty, or any variable not representing a stress fracture occurrence. When raw data were unavailable, we exported risk statistics as reported (e.g. risk ratios[RR], odds ratios[OR], hazard ratios [HR], rate ratios[RR]) as point estimates with 95% confidence intervals (CI) for categorical variables and means with standard deviations or 95% CI for continuous variables. We used imputation tools in Revman to estimate RR when values were not provided. We used the Prediction model Risk Of Bias ASsessment (PROBAST) Tool to assess methodological quality. We conducted a meta-analysis on unique predictor variables. We assessed heterogeneity of predictors using I2 statistics, and when heterogeneity was moderate to high (> 25%), we used a random effects model.

Despite the abundance of literature assessing risk factors for stress fractures, the variability in the capture and reporting of risk factors made data harmonization challenging. Only 3 factors were significantly associated with risk of developing a stress fracture: decreased bone mineral density in females, increased body weight, and female sex. Standardization of collecting and reporting risk factors is necessary in the future to improve the quality of meta-analysis and collective understanding or stress fracture risk factors.

Galvin J, Rooney P, Tokish J, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for poster presentation at the 2024 Arthroscopy Association of North America (AANA) Annual Meeting

Currently the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and tissue of young patients with recurrent anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to determine a peripheral blood transcriptomic biomarker for the reliable delineation of the severity of GBL in anterior shoulder instability patients.

There are significant gene expression differences in the peripheral blood of anterior shoulder instability patients with and without significant (≥10%) GBL. The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic classifier to predict the severity of GBL. This novel peripheral blood transcriptomic biomarker may assist in tracking glenoid bone loss and injury severity and progression in young patients with recurrent anterior shoulder instability.