Characterizing Limb Loss and Absence in Military Health System Beneficiaries: Demographics, Causes, and Trends (2005-2023).

Introduction: An estimated 5.6 million individuals in the U.S.

In-vivo evaluation of vitamin E loaded muscle void fillers for the provisional treatment of volumetric muscle loss.

Objective: This study investigates the therapeutic potential of α-tocopherol (Vitamin E, VitE), delivered locally via a polyethylene glycol (PEG) hydrogel serving as a muscle void filler (MVF), for the acute treatment of volumetric muscle loss (VML) in a rat model. The primary goal was to determine if VitE, a reactive oxygen species scavenger, could exert antioxidant effects at the VML site and thereby improve the recovery of adjacent muscle tissue over a four-week period.

Results: The MVF successfully increased VitE levels in the muscle throughout the implantation period.

Factors associated with concussion during combatives activities in a military training environment.

Background: Military service members routinely participate in combatives training (boxing, judo, martial arts, and hand-to-hand combat) to acquire and maintain mission essential skills. Despite injury mitigation strategies, high concussion incidence rates of 20.8 concussions per 100 exposures while participating in combative sports have been reported.

Low back pain influences medial-lateral trunk movement variations during sit-to-stand tasks in persons with transtibial amputation.

Background: Individuals with lower-limb amputation commonly experience low back pain, which may be associated with altered movement strategies or impaired trunk control during activities of daily living, such as sit-to-stand. The aim of this study was to assess, using wearable sensors, sit-to-stand performance and trunk movement variations of persons with transtibial amputation, with and without low back pain.

Methods: Fifty-eight persons with unilateral transtibial amputation (28 with and 30 without low back pain) performed five sit-to-stand trials while wearing two inertial measurement units affixed to the thigh and sternum.

Evaluation of biological sex on endstage pathobiology and regenerative treatment of volumetric muscle loss.

Volumetric muscle loss (VML) is a severe injury resulting in substantial skeletal muscle loss, leading to a complex pathology that culminates in suboptimal tissue repair and significant long-term functional deficits. This study employs a rodent model of VML to investigate the impact of biological sex on the injury pathobiology and its potential influence on the response to autologous minced muscle grafting (MMG) as a regenerative therapy. While no significant differences were observed between the end-stage male and female responses to VML, both male and female subjects appeared to benefit from MMG treatment.

Overcoming the detrimental impact of volumetric muscle loss on segmental fracture healing via the induced membrane technique.

Aims: Open fractures pose a substantial treatment challenge, with adjacent muscle loss being a major complication. The induced membrane (IM) technique has shown promise in treating complicated fractures. The aim of this study is to investigate the impact of adjacent muscle trauma on segmental fracture healing using recombinant human bone morphogenetic protein-2 (rhBMP-2) via the IM technique.

The central collinear start point in femoral reconstruction nailing decreases ultimate failure load of the femoral neck: a cadaveric biomechanics study.

Objectives: To compare the ultimate and relative failure loads of the femoral neck after insertion of a reconstruction nail through either the central collinear start point or the piriformis start point.

Methods: Twelve bilateral cadaveric femur pairs were assigned to either the central collinear (CC) group or the piriformis fossa (PF) group with an effort to match age distribution, sex, and bone mineral density between the 2 groups. All left femora were used as the surgical specimen, and all right femora were used as their respective intact controls.

Acute Complications of United States Service Members with Combat-Related Lower Extremity Limb Salvage.

: This study examined the incidence of acute complications within the first year following combat-related lower extremity injuries in United States (U.S.) Service members (SMs).

A clinical decision-making algorithm for the personalized prescription of microprocessor-controlled prosthetic knees: An evidence-based approach based on a randomized trial.

Background: Current processes for identifying the best microprocessor-controlled prosthetic knee (MPK) for individuals with transfemoral amputations are subjective, nonscientific, and sometimes fail to consider unique patient needs. Inaccurate prescriptions may hinder a patient's ability to make a speedy rehab.

Objectives: We developed a clinical decision equation that outputs MPK recommendation scores for 3 commercially available MPKs (Power Knee, C-Leg 4.

Characterization of Secondary Health Conditions Among United States Service Members with Combat-Related Lower Extremity Limb Salvage.

Musculoskeletal trauma involving the lower extremities is an unfortunately prevalent injury pattern in contemporary warfare, and the secondary health conditions (SHCs) associated with these injuries remain largely unexplored. U.S.

Healthcare Utilization Among United States Service Members with Combat-Related Lower Extremity Limb Salvage.

: This study assessed healthcare utilization in the first year after combat-related lower extremity injuries in 4275 U.S. Service members.

The musculotendinous interface: insights into development, injury, and recovery for military medical applications.

Musculoskeletal injuries (MSKIs) are a major cause of morbidity and lost duty time for military service members, impacting overall military readiness, with overuse injuries being particularly prevalent among them. Musculotendinous injuries, affecting the musculotendinous unit, are especially problematic due to their long recovery times and limited treatment options. To better understand these injuries, this review delves into the developmental, homeostatic, and structural biology of musculotendinous units, with a focus on the musculotendinous junction (MTJ).

Testing an adjustable prosthetic socket in a simulated military environment.

The purpose of this study was to test the performance of an adjustable socket for transtibial prosthesis users during military relevant tasks. Investigational sockets with motor-driven adjustable panels were fabricated for each participant. Sensors to detect liner-to-socket distance were embedded in the socket wall during fabrication, and collected data were used to calculate a socket fit metric (SFM).

Performance-Based Functional Outcomes 12 and 24 Months After Transfemoral Osseointegration in Service Members With Traumatic Unilateral and Bilateral Lower Limb Loss.

Objective: To evaluate functional outcomes at 12 months and 24 months after transfemoral osseointegration (OI) using established performance-based assessments.

Design: Pre-post observational single cohort.

Setting: Military treatment facility.

Quantifying the Functional Impact of Chronic Patellofemoral Pain and Its Relationship to Perceived Duty-related Medical Readiness Among Active Duty Service Members.

Introduction: Chronic patellofemoral pain (PFP) is a heterogeneous pain condition that may significantly burden active duty service members, whose rigorous physical training demands include activities such as running and heavy load carriage. While chronic PFP is often defined by its pathoanatomical characteristics, evidence from other pain conditions (e.g.

Comparing the mechanical energetics of walking among individuals with unilateral transfemoral limb loss using socket and osseointegrated prosthetic interfaces.

Osseointegration (OI), or bone-anchoring, of a prosthesis is a transformative procedure for addressing issues of socket fit among individuals with lower limb loss. Mechanically, the removal of the socket interface substantially alters the transmission of load and the flow of energy through the prosthetic limb. Here, we compared the mechanical energetics of walking between socket and OI interfaces using biomechanical data and custom models of 8 service members pre- and ~24-months post-OI.

Transfemoral bone-anchored limb use changes dynamic hip muscle forces during walking.

People with unilateral transfemoral amputation commonly experience pain at the residual limb-socket interface and heightened risk of musculoskeletal overuse injuries. Compensatory movement patterns acutely alleviate pain but can contribute to chronic aberrant muscle function and joint loading. Bone-anchored limbs have been shown to normalize joint loading during walking compared to socket prostheses, but their effects on muscle forces are not well understood.

Revealing the Progression of Pain Pathways and Identifying Chronification of Pain Predictors After an Isolated Lateral Ankle Sprain: Project RECOIL.

Persistent pain is a common complaint among civilians and military personnel after a lateral ankle sprain (LAS). Most individuals who experience pain after an LAS self-report a moderate pain intensity level that interferes with activity. This pain experience is mostly described through study designs and outcomes that limit the understanding of the acute to chronic pain transition after an LAS.

Health-related quality of life after major extremity trauma: qualitative research with military service members and clinicians to inform measurement of patient-reported outcomes.

Purpose: The purpose of this study was to understand health-related quality of life (HRQOL) factors for adults who experience major extremity trauma, including limb preservation and amputation, to guide the selection and creation of patient-reported outcome (PRO) measures.

Methods: A thematic content qualitative analysis was used to study service members (SMs) with a history of major extremity trauma and clinical providers with expertise in limb trauma, limb loss, and limb preservation/reconstruction. Focus groups were conducted at three Military Treatment Facilities and one Department of Veterans Affairs Medical Center.

Smaller Width Quadriceps Tendon Grafts Maintain Advantageous Biomechanical Properties for ACL Reconstruction.

Background: Despite clinical evidence of risks in knee arthrofibrosis and graft impingement with larger grafts, the optimal size for quadriceps tendon (QT) autografts in anterior cruciate ligament reconstruction (ACLR) has not been established.

Purpose/hypothesis: This study aimed to evaluate the mechanical properties of full-thickness 6-mm and 8-mm wide QT grafts compared with 10-mm patellar tendon (PT) and 10-mm QT grafts. The hypothesis was that both the 6- and 8-mm QT grafts would exhibit similar or superior ultimate tensile strength compared with the 10-mm PT graft.

"No Matter the Age or Medical Complexity, People Benefit From That Intensity of Exercise": A Mixed-Methods Study Describing Rehabilitation Provider Perceptions of High-Intensity Resistance Training Among Veterans Receiving Post-Acute Care.

Background: In skilled nursing facilities (SNFs), i-STRONGER is a novel, high-intensity resistance training approach that incorporates progressive resistance training to promote greater improvements in patient function compared to usual care. To inform large-scale expansion of i-STRONGER as standard-of-care in SNFs, this mixed-methods study assessed rehabilitation providers' perceptions of i-STRONGER and purported needs for its adoption.

Methods: Forty-three rehabilitation providers participated in an 18-week, interactive i-STRONGER training program.

The effect of carbon fiber custom dynamic orthosis type on kinematics and kinetics of lower extremity joints in individuals with lower limb traumatic injuries.

Background: Carbon fiber custom dynamic orthoses have been used to improve gait mechanics after lower limb trauma in military service members, with the goal of restoring function and improving outcomes. However, the effects of commercially available carbon fiber orthoses available to civilians on lower extremity joint kinetics and kinematics are poorly understood.

Research Question: The aim of this study was to examine the effect of two commercially available orthoses on lower extremity kinematics and kinetics in individuals with lower limb trauma.

Differences in content of care and outcomes between a clinical practice guideline adherent program and usual care for patellofemoral pain: A retrospective pilot study.

Background: Patellofemoral pain (PFP) is a common knee condition in young and active individuals that is managed with highly variable treatment strategies.

Objective: To determine whether the length, number of visits, and content of physical therapy care for patients with PFP differ between a Clinical Practice Guidelines (CPG) adherent program and usual care. Additionally, the percentage of patients reporting clinically important improvements in patient-reported outcomes in each group was evaluated as an exploratory aim.