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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

lai s, soriano j, pham k, wu m, jeon j, o’donovan k, aderm m, trump j, curtain j, gee s, donohue m, cameron k

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: Cases of osteoarthritis (OA) are a common cause of disability among medically separated military service members and rates of OA in the military have been observed at higher rates than the general population. Emerging evidence has revealed an association between intra-articular soft tissue injuries [e.g. meniscus or anterior cruciate ligament (ACL) tears] and cases of OA resulting in total joint replacements. These acute, traumatic soft-tissue injuries typically result in significant hemarthrosis containing inflammatory biochemicals and cells associated with OA. To attain a better understanding of the OA development process, the purpose of this study was to identify whether mesenchymal stem cells (MSC) are present acutely after an intra-articular knee injury and quantify their concentration.

Methods: A prospective case-series study design was conducted among participants enrolled at a United States Service Academy from 2021-2024. Potential subjects with a knee joint injury were referred to and screened by a military orthopedic surgeon to determine eligibility for the study. Eligible subjects underwent informed consented and provided pertinent demographic and injury history information. An aspiration of the knee was conducted during this initial evaluation. Samples were collected within 96 hours of the injury incident. The aspirate sample was tested on a WOLF cell sorter to determine the presence of specific cell surface markers (CD90, CD105, CD73, CD45, CD34, CD19, CD11b, HLA-DR) representative of MSC presence.

Results: It was determined through the WOLF flow cytometer output analysis that cell surface markers consistent with MSC presence were identified in some samples. However, the concentration of cells containing MSC biomarkers remains low and is inconsistent. The observed cell populations demonstrated a biomarker profile more closely resembling peripheral blood mononuclear cells (PBMCs), though varying degrees of MSC marker expression were present.

Conclusion: Preliminary findings suggest that MSCs may be present in the acute phase following intra-articular knee injuries in varying amounts and low quantities. High variability in data across several samples suggests that variability in the mechanism and severity of injury may result in varying physiological responses. Further research controlling for these factors may be needed to better understand the role of MSCs in post-traumatic osteoarthritis development to help inform targeted OA treatment for military personnel.

hughes n, cornell b, rossi r, metzger e, hager n, ketz a, yuan x, wagner l, isaacson b, pasquina p

Abstract accepted for a podium presentation at the 2025 Military Health System Research Symposium

Introduction: Special Operations Forces (SOF) train continually to maintain peak performance. Thus, they are nearly always in a state of recovery and in need of noninvasive therapies to address the taxing workload. Photobiomodulation therapy (PBMT) is a noninvasive treatment where a therapeutic laser is applied to the body to enhance healing, recovery, and performance. Army Tactical Human Optimization Rapid Rehabilitation and Reconditioning (THOR3) provides a consistent venue 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 receiving 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 are investigating the physiologic and behavioral effects of PBMT application post-exercise on performance in SOF Operators.

Methods: We are conducting a single-blind, randomized-control trial in a healthy SOF population. Participants are randomly assigned to receive either PBMT or sham-PBMT post-THOR3, coach-led physical training. Treatment is administered 3 times/week for 3 weeks to both quadriceps. Baseline measurements include body fat percentage, height, weight, and military/demographic information.  The following measurements are collected at baseline and 3-week follow-up: isokinetic/isometric quad and hamstring strength, Borg CR10 Rating of Perceived Exertion, and Elloumi short questionnaire of fatigue. Countermovement jump and self-reported delayed muscle soreness via the Visual Analog Scale are measured at baseline and weekly for three weeks. The Defense and Veterans Pain Rating Scale, self-reported activity, and recovery and sleep via the Oura ring are tracked daily.

Results: The study recently launched. Preliminary results forthcoming at time of conference with an estimated N of 38 completed participants.

Conclusion: PBMT shows promise in accelerating musculoskeletal repair and psychological resilience, reducing injury risk, and enhancing performance in these domains. This study may inform standards of training and care to maximize readiness among elite warfighting units.

rossi r, cin l, grogan s, persinger j, schroeder j, hager n, mincey c, metzger e, gabler g, wagner l, yuan x, isaacson b, pasquina p

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: Lower extremity injuries are common sources of limited duty days for military Service Members. Microvascular flow (MVF) & shear wave elastography (SWE) are postulated to be non-invasive, efficient, & cost effective in early diagnosis/treatment of musculoskeletal injuries (MSKIs). Normative values for MVF, SWE, & related tendon echo-characteristics in the lower leg & Achilles tendon do not exist to our knowledge. Studies reported gender variability of the patellar tendon on ultrasound. Further investigation is needed to determine if there are similar variations in the Achilles tendon. This study aimed to establish normative values for routine tendon echo-characteristics, presence of plantaris tendon, MVF vs P ower Doppler (PD), & SWE measurements in the posterior lower leg & Achilles tendon.

Methods: Ultrasound was performed on asymptomatic participants on a Samsung RS-85 Prestige. Measurements: Achilles calcaneal insertion (CI), avascular zone (AVZ), gastro-soleus junction (GSJ), medial gastrocnemius, & soleus. Outcomes: thickness/width 2D measurements, vessel quantification (PD vs MVF), SWE, plantaris tendon presence, Body Mass Index (BMI), ankle Range of Motion (ROM), & surveys.

Results: 106 limbs scanned (n=55). MVF detected flow in 9 limbs vs 1 limb by PD. Increased BMI increased tendon/gastroc measurements: (p < .01); SWE [r(63) = 0.41] & AVZ SWE [r(63) = .33]. No correlations found between activity levels & ultrasound or ROM measures (p>0.1). Mean SWE of AVZ Short-Axis (SAX) significantly different in males vs females [79.3 kPa (SD: 25.5) vs 64.0 kPa (SD: 10.3), respectively], p=.01). Mean SWE CI: Males: 133.1 kPa (SD: 25.0), females: 124.2 (SD: 31.7); no significant gender differences (p>.01). Median GSJ height Long-Axis (LAX): 0.2 cm. Median CI LAX: 0.4 cm. AVZ height LAX: 0.5 cm. SAX, mean AVZ width: 1.5 cm (SD: 0.2) males & 1.4 cm (SD: 0.2) females; no significant gender differences (p>.01). Plantaris tendons found in 56% of participants. Mean ankle dorsiflexion: males = 13.1° (SD: 10.1), females = 7.2° (SD: 9.9), p=.01.ion.

Conclusion: SWE varied between genders & ultrasound sites. Increased BMI increased tendon/gastroc measurements; higher activity levels did not. Tendon architecture greater in males than females & MVF more sensitive than PD. These findings will inform normal, routine, & novel ultrasound values for the Achilles tendon complex to improve diagnosis & treatment of MSKIs in Military Treatment Facilities

cin l, schroeder j, mincey c, persinger j, hager n, rossi r, metzger e, yimyam c, ketz a, wagner l, isaacson b, yuan x, pasquina p

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: Plantar Fasciitis (PF) is the most common cause of heel pain, affecting 10% of the US population, with a rising annual incident rate. In the United States military, musculoskeletal injuries, including PF, are responsible for 25 million lost duty days, resulting in 2.2 million medical visits. Even if effective, current PF treatment protocols may require 6-12 months of therapy to return individuals to pain-free activity. Photobiomodulation therapy (PBMT) uses non-ionizing light forces to enhance performance, alleviate pain and inflammation, modulate recovery, and promote healing. A recently completed pilot study demonstrated a positive effect of two PBMT parameters on function and pain levels in participants with PF when combined with stretching and ice. This follow-up study assessed the clinical effectiveness of PBMT compared to sham-PBMT in helping individuals return to duty without the use of chronic pain medication or surgical interventions for PF.

Methods: Blinded participants were randomized to PBMT or sham-PBMT 3x/week x 3 weeks at 10 J/cm2, 25W output power using the LightForce XPi and home exercises x 6 weeks. Sham-PBMT participants could crossover after 6-weeks. Outcomes included Defense and Veterans Pain Rating Scale (DVPRS), Foot Functionality Captured via Foot and Ankle Ability Measure (FAAM), and ultrasound measured fascial thickness.

Results: 68 randomized participants (PBMT: n=33, sham-PBMT: n=35) were analyzed. FAAM scores showed improvement for both groups at 6-weeks [PBMT (Mean: 17.2, SD:16.1; p<.01); sham-PBMT (Mean: 10.9, SD:17.1; p=.08)]; no statistically significant intergroup differences (p>.05). Ultrasound measurements reported a median change in PF thickness for PBMT (Mdn: -0.1, IQR: [-0.5;0.5]), and for sham-PBMT (Mdn: 0.3, IQR: [-0.2,0.6]). Regarding pain, both groups experienced improvement in their DVPRS scores [Mdn absolute change -1.0 points (IQR: -2.5;0)]. There were no statistically significant intergroup differences in the above measures.

Conclusions: Both groups met the predefined threshold for a minimum clinically important difference in the FAAM (≥ 8-point decrease) and a decrease in pain (improved DVPRS scores). The PBMT+UC group experienced a small PF thickness decrease compared to sham-PBMT+UC. These findings indicate that PBMT may be an effective adjunctive treatment for PF pain and function.

Goss d, rochester k, melton c, reilly n, marshall a, hess g, ford k

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: All Military Service Members run. The shin and and knee are the most frequently reported injury locations representing 48% of new injuries and 59% of re-injuries (Rauh 2006, Tenforde 2011). Powers et al, (2010) observed that abnormal frontal and transverse plane hip movements have led to patellofemoral pain in runners. Additional work is needed outside the lab to analyze running kinematics. Markerless motion capture systems with cameras has been validated for running and walking data collections.

Methods: Markerless motion capture with 12 cameras were used outside on a track at Fort Bragg, NC. Kinematic running data were collected on 665 Soldiers running through the motion capture volume in 2024. Prospective injury data were mined from the electronic medical record. Kinematic data was processed and analyzed for each step between initial contact to toe off. Two-tailed statistical parametric mapping using a two-sampled t-tests were conducted comparing those presenting with a lower extremity injury to those who did not report a running related injury in the first six months following a data collection in June 2024 to December 2024. The first date of data capture (33 runners) were analyzed and prospectively followed for the initial 6 months to identify those who sustained an injury to those who did not sustain an injury.

Results: Thirty three runners were included in this preliminary analysis. Two hundred and seventy-two steps were analyzed for these 33 runners. There were 136 left and 136 right steps.  Mean steps per participant were 8.24 steps.  Four runners reported to the medical clinic for running-related injuries, while 29 did not. Of the 4 who reported for injury, they demonstrated greater hip adduction for 21% of stance phase  than the 29 healthy Soldiers/runners (t = 2.74, p < .05). No other hip, knee, or ankle sagittal, frontal, or transverse plane differences were observed between the injured and uninjured runners.

Conclusion: These preliminary results are consistent with previous studies that have indicated that increased hip adduction may lead to patellofemoral knee pain in a lab setting. This is the first study of its kind to include markerless motion capture running data of over 30 runners outside. We have over 600 more Soldiers/runners to continue to prospectively track injuries and will have that done prior to the August 2024 MHSRS meeting.

kasper m, smith m, wimmonw w, campbell c, cohen s, wilson s

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: Knee osteoarthritis (KOA) is a pervasive degenerative joint disease that can lead to increased pain, and decreased mobility. Active-duty Service Members (ADSMs) may be at increased risk for developing KOA due to the fitness demands and predisposition for traumatic joint injuries. Patients who have trialed conservative treatments, but do not require surgery, may benefit from alternative procedures including genicular radiofrequency ablations (RFA). Non-surgical interventions are being studied for pain and functional improvement in military and civilian populations.

Methods: The following cases feature participants enrolled in a multi-site study at Walter Reed National Military Medical Center (WRNMMC) [WRNMMC-EDO-2022-0968].  Case 1 is a 56-year-old male retiree with chronic knee pain (> 5 years) and radiographic evidence of left KOA [Kellgren-Lawrence (KL) Score: 2]. Case 2 is a 79-year-old male retiree with chronic right knee pain (1-5 years) and radiographic evidence of right KOA (KL Score: 1). Both patients received genicular RFA procedures targeting nine nerve sites: superomedial, superolateral, inferomedial, inferolateral genicular nerves, nerve to vastus medialis, medial branches of nerve to vastus intermedius, nerve to vastus lateralis, lateral branches of nerve to vastus intermedius, and infrapatellar branch of the saphenous nerve. Patient-reported outcome measures including Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12) and Modified 4-Item Brief Pain Inventory Scale (mBPI) were collected at baseline and 12 weeks post-procedure.

Results: By day 7 post-procedure, both patients reported their knee pain to be very much improved and 0/10. mBPI scores (Case 1: -4.75; Case 2: -3) and KOOS-12 subscale scores for pain (Case 1: -1; Case 2: -6), function (Case 1: -3; Case 2: -6), and quality of life (Case 1: -1; Case 2: -3) improved in both patients at 12 weeks post-procedure.

Conclusion: Investigating the efficacy of modified genicular RFA technique may lead to more comprehensive relief for military beneficiaries. These cases demonstrate this treatment can yield symptom relief as soon as 1-week post-procedure, with improving symptoms and function out to 12 weeks. They are consistent with non-randomized studies demonstrating better improvement with more nerves than the traditional 3-nerve technique.  These study results may support expansion of effective conservative treatment options for military beneficiaries with KOA.

kasper m, smith m, yuan x, noble e, mo

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: Knee osteoarthritis (KOA) is a degenerative joint disease that is five times more likely to affect the military compared to the general population. Patients who have rheumatoid arthritis (RA), in which proinflammatory cytokines can lead to cartilage damage and bone erosion, can also suffer from KOA. Few studies have investigated the use of platelet-rich plasma (PRP) injections in RA patients. The purpose of this prospective case-control series is to compare the safety and efficacy of PRP injections for KOA in patients with and without RA.

Methods: Military beneficiaries (18+ years) with clinical and radiographic [Kellgren-Lawrence Score ≥ 2] evidence of KOA referred for knee PRP injections were enrolled at a military treatment facility (WRNMMC-2022-0406). The RA cohort additionally met diagnosis criteria with current disease dormancy. Exclusion criteria include prior injections (PRP ≤ 6 months; corticosteroid ≤ 3 months), joint replacement, comorbid autoimmune disease, or medical condition that is a PRP contraindication.

Patient-reported outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) collected at baseline, 1-, 3- and 6-months post-procedure..05).

Results: To date, 7 patients have been enrolled (6 KOA, 1 RA+KOA; 42.9% Active duty; 57.1% female). 4 patients (3 KOA, 1RA+KOA) have reached 1-month follow-up for interim analysis, demonstrating symptomatic and functional improvement on their average WOMAC scores (mean ± standard deviation) from baseline to 1-month (24.50 ± 13.82), exceeding the minimal clinically important difference (MCID: 17). Improvement was also seen in all KOOS subscales, although only the pain (8.25 ± 6.13) and activities of daily living (ADL) (17± 9.63) subscales exceeded the MCID threshold (MCID: 8-10). No adverse events (AE) were reported in either group.

Conclusion: Preliminary outcomes of this study demonstrate functional and symptomatic improvement in military beneficiaries with KOA with or without comorbid RA receiving PRP injections. Results of this study will yield additional insight into longer-term functional outcomes and safety of PRP for patients with KOA and RA.

smith m, yuan x, smith j, deal jr j, nanos g, tintle s, reece d, miller m

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: Carpal tunnel release (CTR) using a mini-open (mOCTR) or endoscopic approach is the current standard of care in the Military Health System (MHS) for management of refractory carpal tunnel syndrome (CTS). CTR techniques have evolved to reduce injury risk and post-operative pain. CTR using Ultrasound Guidance (CTR-US) is a promising intervention under study in a trial comparing CTR-US and mOCTR outcomes in MHS beneficiaries.

Methods: This single-site randomized controlled trial at a military treatment facility was approved by the Institutional Review Board (IRB #: WRNMMC-2020-0278). Eligible participants were randomized to receive CTR-US by Physical Medicine and Rehabilitation physicians or mOCTR by Orthopedic Hand Surgeons in clinic procedure room with local anesthesia. CTR-US was performed under continuous ultrasound guidance with device featuring inflatable balloons to create space and a retractable blade to release transverse carpal ligament in retrograde manner.

Primary outcome was Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) at 1 month. Additional outcomes including Boston Carpal Tunnel Questionnaire – Symptom Severity Scale (BCTQ-SSS), Modified 2-item CTS Palmar Pain Scale, and adverse events (AEs) were collected up to 1 year. Descriptive analyses reported central tendencies. Inferential analyses included two-sample Welch’s T-tests (α = 0.01) and generalized additive models (α = 0.05).

Results: 41 patients (58.5% F, 49.5 ± 14.4 years, 41.5% Active duty) were treated (21 CTR-US, 20 mOCTR). Mean CTR-US procedure time was significantly greater (CTR-US: 32.2 ± 14.7 min; mOCTR: 16.2 ± 4.2 min; p < 0.01) and mean CTR-US incision length significantly less than that for mOCTR (CTR-US: 5.4 ± 0.8 mm; mOCTR: 28.0 ± 4.2 mm; p < 0.01). 1 serious AE (infection) was reported in CTR-US group. CTR-US group reported statistically significantly less incisional pain and less impact of incisional pain on function during first 4 weeks and 3 weeks, respectively (p < 0.05).  Both groups had improved QuickDASH and BCTQ-SSS scores out to 1 year with no statistically significant differences (p > 0.05).

Conclusion: Preliminary trial data suggest that CTR-US can be performed within clinic environment by non-operative physicians with advanced training, resulting in decreased incisional pain and non-inferior outcomes compared to mOCTR out to 1 year. Outcomes of WRNMMC trial may expand CTS management and improve operational readiness.

smith m, yuan x, harris e, lechanski l, parson n, condon r

Abstract accepted for a poster session at the 2025 Military Health System Research Symposium

Introduction: Trigger point dry needing (TPDN), also known as dry needling, is an intervention employed by a myriad of providers to treat musculoskeletal (MSK) conditions. This technique uses the insertion of a solid filament needle without medication to treat scarring, myofascial pain and mobility, and muscle motor recruitment dysfunction. Active duty Service Members (ADSMs) are at an increased risk for developing MSK conditions due to their occupational and fitness requirements. Although studies have explored TPDN within this population, supporting use within clinic and deployed environments, most of current literature is lower quality and heterogenous. The study aims to obtain quantitative and qualitative data regarding the current TPDN practices of clinical providers within the Military Health System (MHS).

Methods: This cross-sectional survey-based 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 within the MHS are invited to complete the 33-question survey with the aim of attaining 250 respondents. Training, experience level, safety, outcomes, and barriers to clinical practice will be evaluated. Continuous variables will be presented as means with standard deviations or medians with interquartile ranges. Categorical variables will be presented as counts and proportions. Hypothesis testing will be performed at the 5% significance level, as applicable.

Results: To date, 13 clinicians (13 physical therapists) have completed the survey. 12 respondents currently perform TPDN, and 1 respondent has performed TPDN in the past. Additional analyses will be available at time of report.

Conclusion: MHS providers have been employing TPDN as a cost-effective, low risk and minimally invasive intervention to treat MSK conditions. Considering military personnel can be deployed in a variety of environments, where resources may be scarce, having a minimally invasive intervention at the fingertips of deployed medical personnel is valuable. The results of this study will better inform prospective research protocols to determine the TPDN efficacy in terms of pain reduction, functional improvement, and operational readiness. The survey will also help guide the establishment and standardization of training and clinical practice guidelines, optimize safety and maximize level of confidence/comfort with performing TPDN.

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

Abstract accepted for podium presentation at the 2025 Naval Medical Center Camp Lejeune 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.

m kasper, m smith, s simmons, c campbell, s cohen, s wilson

Abstract accepted for poster presentation at USU Research Days 2025.

Active duty Service Members may be at increased risk for developing knee osteoarthritis  (KOA) due to the fitness demands and predisposition for traumatic joint injuries. Military and civilian  patients may benefit from alternative procedures including genicular radiofrequency ablations (RFA).

Case 1 is a 56-year-old male retiree with chronic knee pain (> 5 years) and radiographic evidence of left KOA [Kellgren-Lawrence (KL) Score: 2]. Case 2 is a  79-year-old male retiree with chronic right knee pain (1-5 years) and radiographic evidence of right KOA (KL Score: 1). Both patients received genicular RFA procedures targeting nine nerve sites: superomedial, superolateral, inferomedial, inferolateral genicular nerves, nerve to vastus medialis, medial branches of  nerve to vastus intermedius, nerve to vastus lateralis, lateral branches of nerve to vastus intermedius,  and infrapatellar branch of the saphenous nerve. Patient-reported outcome measures [i.e., Knee Injury  and Osteoarthritis Outcome Score-12 (KOOS-12), Modified 4-Item Brief Pain Inventory Scale (mBPI)] were collected at baseline and 12 weeks post-procedure.

By day 7 post-procedure, both patients reported their knee pain to be very much improved and  0/10. mBPI scores (Case 1: -4.75; Case 2: -3) and KOOS-12 subscale scores for pain (Case 1: -1; Case 2: - 6), function (Case 1: -3; Case 2: -6), and quality of life (Case 1: -1; Case 2: -3) improved in both patients at  12 weeks post-procedure.

These cases demonstrate the modified genicular RFA technique can yield symptom relief as  soon as 1-week post-procedure, with overall improvement out to 12 weeks, which is consistent with  non-randomized studies demonstrating better improvement with targeting more nerves (nine versus  traditional three). These study results may support expansion of effective conservative treatment  options for military beneficiaries with KOA.