M bejar-chapa, n rossi, n king, d kostyra, m hussey, k mcguire, m randolph, r redmond, j winograd

Peripheral nerve injuries affect 13–23 per 100,000 people annually in the U.S. and often result in motor and sensory deficits. Microsurgical suture repair (SR) is the standard treatment but is technically challenging and associated with complications. Photochemical tissue bonding (PTB), which uses light and a photoactivated dye to bond collagenous tissues, offers a promising alternative. We compared PTB with commercially available collagen membranes for SR and PTB using cryopreserved human amnion (HAM) in a rat sciatic nerve transection model. In total, 75 Lewis rats underwent nerve repair with one of five methods: SR, PTB-HAM, PTB with commercial collagenous membranes (human amnion monolayer (AML), human amnion–chorion–amnion trilayer (ATL), or swine intestinal submucosa (SIS)). Functional recovery was assessed with walking tracks and the Static Sciatic Index (SSI) at days 30, 60, 90, and 120; histological evaluations at days 30 and 120 examined inflammation, axon density, and fascicle structure. No significant differences in SSI scores were found between groups, though PTB-AML and PTB-SIS improved over time. Histology showed inflammation at day 30 that decreased by day 120. Histomorphometry revealed similar axon regeneration across groups. These results suggest that PTB with commercial membranes is a viable alternative to SR.

Bejar-Chapa M, Rossi N, King NC, Kostyra DM, Hussey MR, McGuire KR, Randolph MA, Redmond RW, Winograd JM. Comparison of Photochemically Sealed Commercial Biomembranes for Nerve Regeneration. Journal of Functional Biomaterials. 2025; 16(2):50. https://doi.org/10.3390/jfb16020050

r rossi, j persinger, n hager, s grogan

Abstract accepted for poster presentation at the 2025 Association for Medical Ultrasound Convention in Orlando, Florida.

The current study was initiated to help inform and validate a parallel study being conducted in the same clinical setting. This was done to elucidate the normative values for routine tendon echo-characteristics, presence/absence of plantaris tendon, microvascular flow (MVF), shear-wave elastography (SWE), Power Doppler (PD), & Young’s moduli in the posterior lower leg & Achilles tendon. Both the parallel study and the current one used the Samsung RS-85 Prestige ultrasound and TeleRay Remote for image review/remote exam observation. Additionally, an EZ Exam protocol was standardized across all users and image acquisition was done exclusively by RMSK-certified staff. Imaging was obtained from the gastroc-soleus complex to the Achilles insertion with stop points at the gastrocnemius, soleus, gastroc-soleus junction (GSJ), avascular zone (AVZ), and calcaneal insertion (CI). Our findings confirmed the sensitivity of MVF at detecting flow over PD. We were able to establish normative values for both SWE and in routine Achilles tendon architecture. Additionally, plantaris tendon prevalence in our study population was found to challenge current existing literature. These findings will inform the normal state of the Achilles tendon complex & its related structures with novel ultrasound values in order to improve the diagnosis and treatment progression of musculoskeletal injuries.

l Pham, l gaudette, m funk, k vogel, m bruneau, k silbernagel, j tam, a tenforde

Achilles tendinopathy (AT) is a prevalent running-related injury affecting up to 52% of runners over their lifetime [1]. Tendinopathy represents a failed healing response from an injury to tendon that results in pain, stiffness, loss of function and limits physical activity [2,3]. Patient reported outcome measures (PROMs) are used to understand impairments from injury and monitor healing. AT symptom severity is commonly assessed using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) [4]. However, experts propose the need to develop more comprehensive models to understand tendinopathy and characterize factors beyond pain, including psychological manifestations, anxiety, depression, pain catastrophizing and kinesiophobia [3]. The University of Wisconsin Running and Recovery Index (UWRI) and Patient Reported Outcomes Measurements Information System (PROMIS-29) have each been described to measure impact of injury on runners and health features in the general population, respectively [5,6]. To date, research has not described the association of VISA-A with UWRI or sub-domains of PROMIS measures to understand interactions or unique features that may help understand overall impairments in populations with AT. We hypothesize that VISA-A will be associated with UWRI and physical function measures from PROMIS-29. We also expect measures from PROMIS-29 such as anxiety and depression will not be associated with VISA-A and may be present in a subset of this population.

Pham L, Gaudette LW, Funk MM, et al. Association of functional measures to injury severity in runners with Achilles tendinopathy. PM&R. 2025; 17(6): 726-729. doi:10.1002/pmrj.13314

m Crowell, e florkiewicz, j morris, j mason, w pitt, t benedict, k cameron, d goss

Shoulder stabilization surgery is common among military personnel, causing severe acute postoperative pain that may contribute to the development of chronic pain, thereby reducing military readiness. Battlefield Acupuncture (BFA) has shown promise as a non-pharmaceutical intervention for acute postoperative pain. The purpose of this study was to determine the effectiveness of BFA combined with standard physical therapy on pain, self-reported mood, self-reported improvement, and medication use in patients after shoulder stabilization surgery.

The study design was a single-blind, randomized clinical trial, approved by the Naval Medical Center Portsmouth Institutional Review Board and registered with ClinicalTrials.gov (NCT04094246). Ninety-five participants were recruited after shoulder stabilization surgery. Participants were randomized via concealed allocation into a standard physical therapy (PT) group or a group receiving standard PT and BFA. Both groups received standard postoperative pain medication. The BFA intervention followed a standard protocol with the insertion of gold aiguille d’acupuncture emiermanente needles at 5 specific points in the ear. At 4 time points (baseline [24–48 hours], 72 hours, 1 week, and 4 weeks post-surgery), participants reported worst and average pain using a Visual Analog Scale (VAS), self-reported mood using the Profile of Mood States (POMS), self-recorded medication intake between study visits, and self-reported improvement in symptoms using a Global Rating of Change (GROC) Scale. Outcome assessors were blinded to treatment allocation. An alpha level of 0.05 was set a priori. For pain, a mixed-model analysis of variance was used to analyze the interaction effect between group and time. Differences in baseline data, total opioid usage, and pain change scores between groups were analyzed using independent t-tests.

Of the 95 participants enrolled, 7 failed to provide complete study visits after the baseline, leaving 88 patients (43 BFA, 45 control, mean age 21.8 (2.1) years, 23% female). There were no significant group-by-time interactions for VAS worst pain (F = 0.70, P = .54), VAS average pain (F = 0.99, P = .39), the POMS (F = 1.04, P = .37), or GROC (F = 0.43, P = 0.63). There was a significant main effect of time for VAS worst pain (F = 159.7, P < .001), VAS average pain (F = 122.4, P < .001), the POMS (F = 11.4, P < .001), and the GROC (F = 78.5, P < .001). While both groups demonstrated statistically significant and clinically meaningful improvements in pain and self-reported mood over time, BFA did not provide any additional benefit compared to standard physical therapy alone. There was no significant difference in opioid usage between groups at 4 weeks (t = 0.49, P = .63). Finally, both groups also demonstrated statistically significant and clinically meaningful self-reported improvements in function, but again, there was no additional benefit when adding BFA to standard physical therapy.

The results of this study do not support the effectiveness of BFA for postsurgical pain management as there were no significant differences in pain, self-reported mood, self-reported improvement, and medication use between participants who received BFA and those who did not. As this is the only known study of BFA in postsurgical participants, continued research is needed to determine if BFA is effective for pain reduction in that setting.

Michael S Crowell, Erin M Florkiewicz, Jamie B Morris, John S Mason, Will Pitt, Timothy Benedict, Kenneth L Cameron, Donald L Goss, Battlefield Acupuncture Does Not Provide Additional Improvement in Pain When Combined With Standard Physical Therapy After Shoulder Surgery: A Randomized Clinical Trial, Military Medicine, 2025;, usae577, https://doi.org/10.1093/milmed/usae577

n ghag, j tam, r anderson, n cheema

Histological techniques to study muscle are crucial for assessing skeletal muscle health. To preserve tissue morphology, samples are usually fixed in formaldehyde or cryopreserved immediately after excision from the body. Freezing samples in liquid nitrogen, using isopentane as a mediator for efficient cooling, preserves the tissue in its natural state. However, this method is highly susceptible to freeze-fracture artifacts, which alter or destroy tissue architecture. Isopentane is most commonly used in a semi-frozen/liquid state that is visually assessed by the experimenter, which can pose a challenge when freezing multiple tissues at a time or maintaining a consistent temperature. Furthermore, tissue size is also a confounding factor; depending on the size, freezing times can vary. In this study, we compare two different options for using isopentane while cryopreserving tissue. We also present an easy and reproducible method of freezing the soleus tissue of mice using frozen isopentane. This method decreased the occurrence of freeze-fractures by an order of magnitude, to ~4%, whereas the traditional method of cryopreservation resulted in ~56% freeze-fracturing.

Ghag, N., Tam, J., Anderson, R. R. and Cheema, N. (2025). Cryopreservation Method for Preventing Freeze-Fracture of Small Muscle Samples. Bio-protocol 15(1): e5145. DOI: 10.21769/BioProtoc.5145.

d rhon, s de la motte, j fraser, t greenlee, b hando, j molloy, d teyhen, j tiede, j van wyngaarden, r westrick, g bullock

Musculoskeletal injuries enact a substantial burden in military settings, incurring high costs, long-term disability, and impacting military readiness. This has led to a prioritization of injury prevention programs. Understanding the challenges faced by those trying to implement these programs could help standardize and better inform future efforts. The purpose was to capture perceptions of barriers and facilitators to implementation of injury prevention programs in the US Armed Forces.

A cross-sectional survey with open-ended questions was circulated to relevant stakeholders; key themes were derived using conceptual content analysis. Four questions were asked concerning injury prevention programs: 1) barriers, 2) facilitators, 3) how can leadership best support, and 4) how can subject matter experts best collaborate to make these programs successful?

The survey reached at least 300 individuals working with the armed services worldwide; 91 completed the survey. The mean (SD) time working with military service members was 11.5 (8.2) years; 93 % worked with active-duty service members, 71.4 % were licensed healthcare providers, and 55 % worked in settings with established injury prevention programs. Only 45.2 % of participants believed an appropriate, clear way to measure program success currently exists. Nearly 85 % believed that lacking standardization of definitions and metrics hinders program assessment. Wide variability existed in opinions regarding who should be primarily responsible for promoting/supporting injury prevention efforts. Key themes included resources as both a facilitator (when present) and barrier (when absent), organizational culture, and leadership support. Leadership can best help by prioritizing the programs and valuing the programming through modeling the desired behavior. Program staff can collaborate by focusing on enabling change, integrating into organizational/unit culture and collaborating with leaders to change policy.

Daniel I. Rhon, Sarah J. de la Motte, John J. Fraser, Tina A. Greenlee, Benjamin R. Hando, Joseph M. Molloy, Deydre S. Teyhen, Jeffrey M. Tiede, Joshua J. Van Wyngaarden, Richard B. Westrick, Garrett S. Bullock. Perceived barriers and facilitators to implementation of injury prevention programs in the military: feedback from inside the trenches, Injury. 2024. 112029. ISSN 0020-1383, doi.org/10.1016/j.injury.2024.112029.

b hando, v pav, b isaacson, c colahan, w funk, x yuan

The U.S. Military Health System (MHS) transitioned to the ICD-10-CM coding scheme in October 2015 and began the phased rollout of a new electronic health record system, MHS GENESIS, in October 2017. Both changes have the potential to affect the observed prevalence and health care utilization associated with musculoskeletal injuries (MSKIs) in service members. The purpose of this article was to (1) determine the effect of the ICD-10-CM transition on the observed prevalence of select MSKI conditions and (2) describe MSKI-related health care utilization in four MTFs during the adoption of MHS GENESIS.

Ben Hando, Veronika Pav, Brad Isaacson, Courtney Colahan, Wendy Funk, Xiaoning Yuan, Musculoskeletal Injury Surveillance in the U.S. Military: Analysis of the ICD-10-CM Transition and Descriptive Report of Health Care Utilization at Four Sites Adopting MHS GENESIS, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 78–86, https://doi.org/10.1093/milmed/usad462

v pav, x yuan, b isaacson, w funk, b hando

Musculoskeletal injuries (MSKIs) represent the most common, costly, and impactful medical conditions affecting active duty service members (ADSMs) of the United States Armed Forces. Inconsistent, variable MSKI surveillance methods and often incompletely described criteria for cohort selection, injuries, incidence, and prevalence have limited efforts to observe longitudinal trends, identify gaps in care, or highlight specific military branches or sites that could benefit from enhanced MSKI intervention protocols. The purpose of this manuscript is to present a comprehensive, well-documented, and reproducible framework for capturing and categorizing MSKI burden, healthcare utilization, and private sector costs for ADSMs across a 12-year period spanning the International Classification of Diseases, 10th Revision, Clinical Modification transition.

Veronika Pav, Xiaoning Yuan, Brad Isaacson, Wendy Funk, Ben Hando, Capturing and Categorizing the Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A Comprehensive Methodology, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 70–77, https://doi.org/10.1093/milmed/usae245

b isaacson, b hando, p pav, l wagner, c colahan, p pasquina, x yuan

Lower Extremity musculoskeletal injuries (LE MSKIs) represent a significant portion of overuse injuries in active duty service members (ADSMs). However, variations in study methods and research gaps related to LE MSKIs have prevented Department of Defense (DoD) leaders from assessing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of LE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan, Lower Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 56–69, https://doi.org/10.1093/milmed/usae046

x yuan, e stewart, c colahan, p pasquina, b isaacson, v pav

Low back pain and musculoskeletal injuries (MSKIs) of the Spine are the most common reason for U.S. active duty service members (ADSMs) to seek medical care. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Spine (thoracic, lumbar, sacral, and pelvic) MSKIs across the four major branches of service from Fiscal Years (FY) 2016 to 2021.

Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando, Musculoskeletal Spine Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Healthcare Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 45–55, https://doi.org/10.1093/milmed/usae248

b isaacson, b hando, v pav, l wagner, c colahan, p pasquina, x yuan

Upper Extremity musculoskeletal injuries (UE MSKIs) represent a major threat to the overall health and readiness of U.S. active duty service members (U.S. ADSMs). However, a lack of prior research and inconsistent study and surveillance methodology has limited Department of Defense (DoD) leaders from assessing and addressing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of UE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan, Upper Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 34–44, https://doi.org/10.1093/milmed/usae047

x yaun, e stewart, c colahan, p pasquina, b isaacson, v pav, b hando

Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021.

Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando, Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 22–33, https://doi.org/10.1093/milmed/usae045

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

Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period.

Courtney Colahan, Veronika Pav, Xiaoning Yuan, Brad Isaacson, Linzie Wagner, Ben Hando, Musculoskeletal Injuries in Female U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 10–21, https://doi.org/10.1093/milmed/usae308

V Pav, x yuan, b isaacson, c colahan, b hando

Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period.

Veronika Pav, Xiaoning Yuan, Brad Isaacson, Courtney Colahan, Ben Hando, Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A 12-Year Study Spanning Fiscal Years 2010–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 1–9, https://doi.org/10.1093/milmed/usae357

Galvin J, Milam r, patterson b, mepola j, buckwalter j, wolf b, say f, free k, yohannes e

Abstract accepted for platform presentation at the 2024 Society of Military Orthopaedic Surgeons (SOMOS) Annual Meeting

The incremental biological changes in the synovial microenvironment of the shoulder in acute and chronic instability that may contribute to joint degeneration are poorly understood. Proteomic analysis of synovial fluid in patients with shoulder instability may improve our understanding of proteins that are shed into shoulder synovial fluid after an injury.

Proteomic analysis enriched our understanding of proteins that were secreted into shoulder synovial fluid of patients with shoulder instability. The identification of POSTN, a proinflammatory catabolic protein involved with tissue remodeling and repair, as a significant target in anterior shoulder instability is a novel finding. Therefore, further study is warranted to determine the role that POSTN may play in the progression of bone loss and posttraumatic osteoarthritis.

e Florkiewicz, k east, m crowell, a weart, g freisinger, d goss

In-clinic gait retraining has been effective in modifying suspected biomechanical risk factors for running injury, but its feasibility is often limited by multiple clinic visits. This randomized clinical trial investigated the effects of a telehealth-based gait retraining intervention on running biomechanics, pain, and function in previously injured runners.

Twenty-three participants recovering from lower extremity injuries were randomized to a control or intervention group. The intervention group completed 4 to 6 telehealth gait retraining sessions over 8 to 10 weeks, consisting of visual and verbal cues to transition to a non-rearfoot strike pattern and increase step rate. The control group received standard physical therapy. Biomechanics, pain, and function were assessed pre- and post-intervention using a 2 × 2 mixed model analysis of variance.

Half of the participants (55 %) in the intervention group successfully transitioned to a non-rearfoot strike pattern. No significant differences were observed between groups in step rate, biomechanics, or function. A significant group-by-time interaction for pain was observed (F = 10.55, P = 0.004), with the intervention group reporting greater reductions in pain compared to the control group (mean difference 2.52, 95 % CI 0.91 to 4.12).

Erin M. Florkiewicz, Kyle H. East, Michael S. Crowell, Amy N. Weart, Gregory M. Freisinger, Donald L. Goss. The effects of telehealth running gait retraining on biomechanics, pain, and function in patients with lower extremity injuries: A randomized clinical trial. Clinical Biomechanics, 2024. 106381, ISSN 0268-0033. https://doi.org/10.1016/j.clinbiomech.2024.106381.

m Crowell, e florkiewicz, j morris, j mason, w pitt, t benedict, k cameron, d goss

Abstract accepted for platform presentation at the 2025 American Physical Therapy Association Combined Sections Meeting- Houston, TX

Purpose/hypothesis: Shoulder instability is common in active young athletes and military personnel, often requiring shoulder stabilization surgery. Acute post-operative pain is usually managed with opioid pain medications, which have adverse effects that reduce military readiness. Battlefield Acupuncture (BFA) has demonstrated promise as a non-pharmaceutical intervention for acute post-operative pain. The purpose of this randomized clinical trial was to assess the effectiveness of BFA on post-surgical pain and opioid medication usage.

i gaunaurd, m sumner, p pasquina, a symsack, j haynes, c bennett, r gailey

Abstract accepted for platform presentation at the 2025 American Physical Therapy Association Combined Sections Meeting- Houston, TX

Purpose/hypothesis: Veterans with lower limb loss (LLL) are a complex population with their own unique challenges with rehabilitation but share many commonalities with the general population. This case series highlights two examples of a physical therapist and patients with LLL who participated in the Mobile Device Outcomes Based Rehabilitation Program at the Bruce W. Carter VA Medical Center, Miami, FL using a novel mobile sensor system and application called Rehabilitative Lower Limb Orthopaedic Assistive Device (ReLOAD) to augment rehabilitation.

i gaunaurd, p pasquina, a symsack, m sumner, j haynes, t fields, a munoz-boyle, l prasso, christina sole-plasa, j stevens, c bennett, b applegate, b isaacson, r gailey

Abstract accepted for platform presentation at the 2025 American Physical Therapy Association Combined Sections Meeting- Houston, TX

Purpose/hypothesis: Supported by the DoD/VA Joint Incentive Fund, Mobile Device Outcomes-based Rehabilitation Program (MDORP) utilizes mobile technology, called Rehabilitative Lower Limb Orthopedic Assistive Device (RELOAD) to enhance the rehabilitation of Services Members (SMs) and Veterans with lower limb loss (LLL). The ReLOAD system assesses walking quality, provides auditory feedback to correct gait deviations, and recommends patient-speci c exercises that target their impaired function and limitations. The purpose of this study is to examine the use of the RELOAD system in the clinical practice of Physical Therapists (PTs) to optimize assessment and care of SMs and Veterans with LLL.

A Symsack, i gaunaurd, j haynes, m sumner, c bennett, b isaacson, p pasquina, r gailey

Abstract accepted for platform presentation at the 2025 American Physical Therapy Association Combined Sections Meeting- Houston, TX

Purpose/hypothesis: The home-based exercise program (HEP) for patients in rehabilitation following lower limb loss (LLL) is an integral part of the continuity of care outside the clinic for the maintenance and improvement of strength, mobility, and functional goals. However, clinical evidence shows that patients have varying degrees of exercise adherence to HEPs. Evidence-based exercise prescription to improve HEP adherence has suggested dosing of 20 minutes daily, minimum of three times per week or the completion of two-thirds of the prescribed exercise routine. The purpose of this study is to determine patient adherence to their HEP among SMS and Veterans with LLL using the Rehabilitative Lower Limb Orthopaedic Assistive Device (ReLOAD).