Aderman, M. J., Brett, B. L., Ross, J. D., Malvasi, S. R., McGinty, G., Jackson, J. C., Estevez, C. A., Brodeur, R. M., Svoboda, S. J., McCrea, M. A., Broglio, S. P., McAllister, T. W., Pasquina, P. F., Cameron, K. L., & Roach, M. H. (2023). Association between symptom cluster endorsement at initiation of a graduated return-to-activity protocol and time to return to unrestricted activity after concussion in United States service academy cadets. The American Journal of Sports Medicine, 51(11), 2996–3007. https://doi.org/10.1177/03635465231189211

This prospective cohort study examined the relationship between graduated return-to-activity protocol initiation and concussion symptoms in 961 cadets enrolled at three U.S. service academies. Current recommendations are that symptomatic individuals should not enter the GRTA protocol until symptoms resolve. This study found that approximately one-third of concussed individuals began the GRTA protocol when symptomatic. These symptomatic individuals took 16-19% longer to complete the protocol. This report highlights the importance of proper concussion treatment and GRTA protocol initiation to avoid prolonged return-to-activity.

Aderman, M. J., Meister, M. R., Roach, M. H., Dengler, B. A., Ross, J. D., Malvasi, S. R., & Cameron, K. L. (2023). Normative values for pupillary light reflex metrics among healthy service academy cadets. Mil Med. https://doi.org/10.1093/milmed/usad271

The purpose of this study was to collect normative values for eight pupillary light reflex metrics among healthy service academy cadets based on sex, age, sleep, race, ethnicity, anisocoria, and concussion history. Of the 514 cadets that completed a valid baseline PLR assessment, sex, age, sleep, and race resulted in significant differences in PLR metrics while concussion history and anisocoria did not impact PLR metrics. These findings need to be considered when measuring PLR.

Anderson, A. B., Dekker, T. J., Pav, V., Mauntel, T. C., Provencher, M. T., Tokish, J. M., Volker, M., Sansone, M., Karlsson, J., & Dickens, J. F. (2023). Survival of anterior cruciate ligament reconstructions in active-duty military populations. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 3196-3203. https://doi.org/10.1007/s00167-023-07335-w

This retrospective study examined failure of anterior cruciate ligament reconstruction. Of the 2,735 cases evaluated, 18% percent of Service members experience an ACLR failure within four years. Time from injury to surgical repair (>180 days) and tobacco use were identified as factors that increased risk of ACLR failure. These findings provide an opportunity to reduce ACLR failure risk by encouraging smoking cessation in service members and prompt treatment following injury.

Barber, P., Pontillo, M., Bellm, E., & Davies, G. (2023). Objective and subjective measures to guide upper extremity return to sport testing: A modified Delphi survey. Physical Therapy in Sport, 62, 17–24. https://doi.org/10.1016/j.ptsp.2023.05.009

A modified Delphi study was utilized to establish criteria when an individual is ready to return to sporting activities following an upper extremity injury. The expert panel reached consensus on objective and subjective criteria that should be utilized. These criteria include timeframes required for tissue healing, pain levels, strength, range of motion, and the utilization of patient reported outcomes. This study provides a group of measures that should be utilized to determine when individuals who have suffered an upper extremity injury can return to sporting activity.

Buckley, T. A., Chandran, A., Mauntel, T. C., Kerr, Z. Y., Brown, D. W., Boltz, A. J., Herman, D. C., Hall, E. E., & Lynall, R. C. (2023). Lower extremity musculoskeletal injuries after concussion in collegiate student-athletes. The American Journal of Sports Medicine, 51(2), 511-519. https://doi.org/10.1177/03635465221125155

This retrospective study examined 10 years of National Collegiate Athletic Association Surveillance Program data to evaluate the risk of lower extremity musculoskeletal injury following concussion or previous musculoskeletal injury. Of the 31,556 injuries evaluated, first injury type, either concussion or upper extremity musculoskeletal injury, was not associated with an elevated risk of lower extremity musculoskeletal injury. The lack of an association between concussion and risk of sustaining a lower extremity musculoskeletal injury is contrary to smaller, single-institution studies.

Butowicz, C. M., Hendershot, B. D., Watson, N. L., Brooks, D. I., Goss, D. L., Whitehurst, R. A., Harvey, A. D., Helton, M. S., Kardouni, J. R., Garber, M. B., & Mauntel, T. C. (2022). Pre-neuromusculoskeletal injury Risk factor Evaluation and Post-neuromusculoskeletal injury Assessment for Return-to-duty/activity Enhancement (PREPARE) in military service members: A prospective, observational study protocol. Journal of Translational Medicine, 20(1), 619. https://doi.org/10.1186/s12967-022-03832-7

This paper describes the development of a prospective-observational study to identify a comprehensive group of clinical assessments to identify factors contributing to musculoskeletal injury risk and undesired post-injury outcomes. The identified clinical assessments, mitigation and rehabilitation strategies will then be validated in the second phase of this effort.

Butowicz, C. M., Helgeson, M. D., Pisano, A. J., Cook, J. W., Dearth, C. L., & Hendershot, B. D. (2023). Lumbar degenerative disease and muscle morphology before and after lower limb loss in four military patients. Military Medicine, 188(11-12), e3349–e3355. https://doi.org/10.1093/milmed/usac399

Lower back pain is common among individuals with lower limb amputation. This is the first report describing longitudinal changes in spine health before and after amputation in four individuals that were being treated for LBP prior to unilateral LLA. While lumbar muscle size did not change after LLA, the fat content increased in combination with increases in facet and intervertebral disc degeneration. This paper provides important insight into how LLA can influence LBP.

Butowicz, C., Yoder, A. J., Hendershot, B. D., Gunterstockman, B., & Farrokhi, S. (2023). Principal components analysis of postural sway in persons with unilateral lower limb amputation: A wearable sensor approach. Journal of Biomechanics, 158, 111768. https://doi.org/10.1016/j.jbiomech.2023.111768

This paper describes the use of a commercially available wearable sensor to assess postural control in persons with lower limb amputation. The authors identified six principal components that captured impaired postural control. These findings support the concept of using wearable sensors to measure postural control quickly and objectively.

This review examines currently available fracture stabilizing devices and techniques and highlights the need for solutions that can enable mobility following lower limb fractures in austere environments.

Staged surgical approaches can be effective when treating large, complex injuries. In this study, three muscle void fillers were evaluated to stabilize a volumetric muscle loss injury. Polyvinyl alcohol emerged as the most suitable material for maintaining injury volume while minimizing adverse effects to surrounding muscle.

This manuscript reviews the evidence of effectiveness and use of FDA approved therapeutics targeting anabolic pathways, energy metabolism, tissue perfusion, and bone formation for the treatment of musculoskeletal injuries. A growing body of evidence is presented supporting the use of these therapies, which can be effective in reducing pain, improving range of motion, and increasing muscle strength.

Anterior cruciate ligament rupture is among the most common injuries in active individuals. As ACL repair methods improve, studies have shown that backup fixation improves failure load and decreases elongation of the reconstructed ACL. The study evaluated the biomechanical profile of composite bone using subcortical backup fixation in ACL reconstruction with a bicortical post and washer and suture anchor when used with interference screw as the primary fixation, and to evaluate the utility of backup fixation for tibial fixation with extramedullary cortical button primary fixation. All backup fixation groups were stronger than the control group with IS fixation only (P < .001). There was also no significant difference in outcome measures between the extramedullary suture button groups with and without the BP. This study provides evidence that subcortical backup fixation is a viable alternative for ACL reconstruction; however, there is no advantage to adding backup fixation to extramedullary button (all-inside) primary fixation when all suture strands are secured to the extramedullary button.

Colantonio, D. F., Le, A. H., Pisano, A. J., Chung, J. M., Wagner, S. C., Fredericks, D. R., Roach, W. B., Schlaff, C., Dill, A., Mauntel, T. C., Hendershot, B. D., & Helgeson, M. D. (2023). Hooks versus pedicle screws at the upper instrumented level: An in vitro biomechanical comparison. Spine, 48(7), E94–E100. https://doi.org/10.1097/BRS.0000000000004547

Proximal junctional kyphosis, or excessive angular displacement above fused vertebrae, is a complication following posterior spinal fusion. To determine options to decrease PJK following spinal fusion, two fusion methods were evaluated for range of motion in a cadaveric model: (1) transverse process hooks and (2) bilateral pedicle screws. Following cyclic loading, BPS constructs had greater motion in the adjacent vertebrae compared to bilateral TPH. The data suggests that the rigidity of the BPS method resulted in greater motion compared to a “softer transition” of the TPH construct. Further evaluation in clinical studies is warranted to determine if PJK can be reduced by using different techniques.

Colantonio, D. F., Tucker, C. J., Murphy, T. P., Mescher, P. K., Le, A. H., Putko, R. M., Holm, E. R., Weishar, R., Vippa, T. K., Rudic, T. N., & Chang, E. S. (2022). All-suture suspensory button has similar biomechanical performance to metal suspensory button for onlay subpectoral biceps tenodesis. Arthroscopy, Sports Medicine, and Rehabilitation, 4(6), e2051–e2058. https://doi.org/10.1016/j.asmr.2022.09.004

Multiple surgical techniques exist for fixation of biceps brachii, a common source of pain and tendinopathy with rotator cuff tears. In this study, two techniques were compared: intramedullary unicortical metal button and unicortical all-suture button using eighteen matched paired human cadaveric proximal humeri. Although the MB showed statistically significant greater maximal load to failure, there was no difference between the MB and ASB when the suture-tendon interface was eliminated. Suture pull through was the most common mode of failure for both implants, underscoring the importance of the suture tendon interface.

As life saving techniques have improved on the battlefield, service members are surviving extreme trauma with significant trauma to their extremities. In lieu of primary amputation, many service members receive extensive surgical and rehabilitative treatments referred to as limb salvage. This study describes an unbiased method using medical coding to identify individuals who have undergone limb salvage following a lower extremity injury. The sensitivity and specificity using this method were identified as 55.6% (expert range of 51.8-66.7%) and 87% (expert range of 73.9%-91.3%), respectively.

Weight management after lower limb amputation is important to prevent secondary conditions such as cardiovascular disease, diabetes, and osteoarthritis. Nine-hundred and thirty-one service members with unilateral or bilateral LLAs were identified for the study. The majority of individuals (58%) maintained a stable weight, 38% had weight gain, and weight loss occurred in 4%. Individuals with bilateral amputations were more likely to experience weight loss than those with unilateral amputations. Blast injury, versus other trauma, and individuals less than 20 years old were more likely to be assigned to the weight gain group.

Hunzinger, K. J., Cameron, K. L., Roach, M. H., Jackson, J. C., McGinty, G. T., Robb, J. B., Susmarski, A. J., Estevez, C. A., McAllister, T. W., McCrea, M., Pasquina, P. F., & Buckley, T. A. (2023). Baseline concussion assessment performance by sex in military service academy rugby players: Findings from the CARE Consortium. BMJ Mil Health. https://doi.org/10.1136/military-2023-002358

This study examined baseline concussion assessment performance of military academy rugby athletes to determine the effect of sex and concussion history on these measures. Six-hundred and one service academy rugby players were evaluated. Women reported greater symptoms than men and performed worse on visual memory. Rugby athletes with a history of concussion reported lower symptom severity scores than those without a concussion history. This reference data will aid in future assessment and treatment of service academy rugby players.

Johnson, W. B., Prost, V., Mukul, P., & Winter V, A. G. (2023). Design and evaluation of a high-performance, low-cost prosthetic foot for developing countries. Journal of Medical Devices, 17(1), 011003. https://doi.org/10.1115/1.4055967

Advanced prosthetic feet are extremely expensive and cost-prohibitive in many parts of the world. This paper describes the design and testing of a novel, high-performance, lower-cost, durable, mass-manufacturable, and socially acceptable cosmetic foot for use in the global market.

Johnson, W., Young, A., Goldman, S., Wilson, J., Alderete, J., & Childers, W. L. (2023). Exoskeletal solutions to enable mobility with a lower leg fracture in austere environments. Wearable Technologies, 4, E5. https://doi.org/10.1017/wtc.2022.26

This review provides an evaluation of currently available exoskeletons and how they could be utilized and enhanced to enable mobility following a tibia fracture in an austere environment.

Kaufman, K. R., Miller, E. J., Deml, C. M., Sheehan, R. C., Grabiner, M. D., Wyatt, M., Zai, C. Z., Kingsbury, T., Tullos, M. L., Acasio, J. C., Mahon, C. E., Hendershot, B. D., & Dearth, C. L. (2023). Fall prevention training for service members with an amputation or limb salvage following lower extremity trauma. Military Medicine, usad005. Advance online publication. https://doi.org/10.1093/milmed/usad005

Falls and fear of falling are a significant issue for those with lower limb loss. To expand on the earlier development of a fall-prevention program for persons with limb loss, this study enrolled 45 service members with varying severity of lower limb traumatic injuries. The two-week program consisted of six 30-minute sessions on a bi-directional treadmill that introduced three perturbations of increasing difficulty as the participant became more skilled at maintaining posture. Three and six months after training, individuals retained their ability to respond to gait disturbances and reported fewer falls and increased walking confidence. This novel training technique shows promise for reducing fall risk in persons with lower limb trauma.

Kulwatno, J., Goldman, S. M., & Dearth, C. L. (2023). Volumetric muscle loss: A bibliometric analysis of a decade of progress. Tissue engineering. Part B, Reviews, 29(3), 299–309. https://doi.org/10.1089/ten.TEB.2022.0150

The field of volumetric muscle loss has expanded in recent years. This bibliometric review examines the literature and direction of this field of study. At the time of publication, over 70% of the VML literature investigated the use of biomaterials as a therapeutic approach. Also, 43 patents were filed (12 issued) which indicates an increasing level of maturity for products to address VML.

Lluch-Girbés, E., Requejo-Salinas, N., Fernández-Matías, R., Revert, E., Vila Mejías, M., Rezende Camargo, P., Jaggi, A., Sciascia, A., Horsley, I., Pontillo, M., Gibson, J., Richardson, E., Johansson, F., Maenhout, A., Oliver, G. D., Turgut, E., Jayaraman, C., Düzgün, I., Borms, D., Ellenbecker, T., & Cools, A. (2023). Kinetic chain revisited: Consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain. Journal of Shoulder and Elbow Surgery, 32(8), e415–e428. https://doi.org/10.1016/j.jse.2023.01.018

Movement patterns in dynamic upper extremity tasks are produced through a series of interrelated segments known as the kinetic chain. Because no current agreement exists how to involve the KC in patents with shoulder pain, this study was conducted to obtain consensus among shoulder experts using the Delphi method. The most appropriate terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatments were evaluated. The study identified a list of 102 items across five different domains (terminology, rationale and clinical reasoning, subjective examination, physical examination, and treatment) relating to KC in people with shoulder pain that require further study and validation.

Lee, S. P., Farrokhi, S., Kent, J. A., Ciccotelli, J., Chien, L. C., & Smith, J. A. (2023). Comparison of clinical and biomechanical characteristics between individuals with lower limb amputation with and without lower back pain: A systematic review and meta-analysis. Clinical Biomechanics (Bristol, Avon), 101, 105860. https://doi.org/10.1016/j.clinbiomech.2022.105860

This systematic review with meta-analysis evaluated risk factors associated with lower limb amputation and lower back pain. Thirteen studies were included, with aggregated data from 436 participants (239 with LBP; 197 pain free) who were predominantly male and with trauma-related amputation. No significant differences in trunk/pelvic kinematics during gait were detected (p = 0.07–0.446) between the groups. Similarly, demographic, anthropometric, and simple clinical outcome measures were not significantly different between the LBP and control groups. The meta-analysis suggests that biomechanical, demographic, anthropometric, and simple clinical outcome measures were incapable of identifying the risk of developing LBP after amputation.

Recent studies have stressed the important role of the deltoid ligament in maintaining global ankle stability. However, controversy remains around whether deltoid ligament repair is necessary in addition to syndesmotic repair when addressing injuries to both. In this study, 12 cadaveric ankles were used and there were no differences in overall mean ankle contact pressures between the various tested conditions; however, the joint contact area decreased with a shift in the distribution of contact pressures after syndesmosis versus deltoid repair. With a deltoid repair alone, the distribution of contact pressures and the joint contact area did not differ significantly from the native state. These changes in contact area and distribution of pressures may affect long-term clinical outcomes and require further evaluation.

Lynall, R. C., Wasser, J. G., Brooks, D. I., Call, J. A., Hendershot, B. D., Kardouni, J. R., Schmidt, J. D., & Mauntel, T. C. (2023). Investigating post-mild traumatic brain injury neuromuscular function and musculoskeletal injury risk: A protocol for a prospective, observational, case-controlled study in Service members and active individuals. BMJ Open, 13(3), e069404. https://doi.org/10.1136/bmjopen-2022-069404

This paper describes the protocol to characterize the neuromuscular mechanisms contributing to the increased risk of musculoskeletal injury following a mild traumatic brain injury. This 124-participant longitudinal study commenced in October 2022 and includes, dynamic movement assessments, sensory assessments, neuromuscular assessments, and patient reported outcomes.

Mahon, C. E., Hendershot, B. D., Gaskins, C., Hatfield, B. D., Shaw, E. P., & Gentili, R. J. (2023). A mental workload and biomechanical assessment during split-belt locomotor adaptation with and without optic flow. Experimental Brain Research, 241(7), 1945–1958. https://doi.org/10.1007/s00221-023-06609-6

Physical and neurologic adaptation is required to maintain balance and motion. This is the first study to examine mental workload changes using electroencephalography during split-belt treadmill walking with and without optic flow (static versus a moving image). Data from these 13 uninjured individuals will serve as the basis for future studies with the long-term objective of applying new or additional interventions to treat gait asymmetries.

Maikos, J. T., Hendershot, B. D., Pruziner, A. L., Hyre, M. J., Chomack, J. M., Phillips, S. L., Heckman, J. T., Sidiropoulos, A. N., Dearth, C. L., & Nelson, L. M. (2023). Criteria for advanced prosthetic foot prescription: Rationale, design, and protocol for a multisite, randomized controlled trial. JMIR Research Protocols, 12, e45612. https://doi.org/10.2196/45612

Prosthetic foot prescription is typically based on the professional judgement of the provider. To assist in the prescription process, a multi-site, randomized crossover clinical trial will be conducted for up to 100 participants. This paper describes the study design with the overarching goal of developing evidence-based guidelines for the prescription of prosthetic ankle-foot devices.

McKinley, T. O., Natoli, R. N., Janakiram, N. B., Warden, S. J., Fuchs, R. K., Gunderson, Z., Diggins, N., Sun, S., Kolettis, G., Goldman, S. M., Dearth, C. L., Mendenhall, S., Staut, C., Kacena, M. A., & Corona, B. T. (2023). Minced muscle autografting improves bone healing but not muscle function in a porcine composite injury model. Journal of Orthopaedic Research, 41(9), 1890–1901. https://doi.org/10.1002/jor.25551

The objective of this study was to determine if skeletal muscle autografting with minced muscle grafts could improve healing in a segmental bone defect and improve muscle function in a porcine composite tissue injury model. While MMG did improve bone healing, it did not improve muscle function. Also, the presence of an SBD resulted in fibrosis and weakness in adjacent muscle tissue. This observation suggests a broader role and interaction between bone and muscle healing.

Murphy, T. P., Colantonio, D. F., Le, A. H., Fredericks, D. R., Schlaff, C. D., Holm, E. B., Sebastian, A. S., Pisano, A. J., Helgeson, M. D., & Wagner, S. C. (2023). Biomechanical analysis of multilevel posterior cervical spinal fusion constructs. Clinical Spine Surgery, 36(5), E212–E217. https://doi.org/10.1097/BSD.0000000000001429

Posterior spinal fusion is an effective treatment for a variety of cervical spine pathologies; however, the length of the fusion (how distal/caudal) remains controversial due to risk for adjacent segment degeneration and need for revision. In this study, 15 cadaveric spines were evaluated for range of motion using three different fusion lengths. This first of a kind biochemical study demonstrates that spinal fusion constructs that cross the cervicothoracic junction have a lower range of motion across this junction. These data suggest that crossing cervicothoracic junction may lower rates of adjacent segment degeneration and reduce the need for subsequent revision surgery.

Monaghan, P. G., Knight, A. D., Brinkerhoff, S. A., Harrison, K. D., Dearth, C. L., Hendershot, B. D., Sefton, J. M., Zabala, M., Vazquez, A., Shannon, D., Crumbley, D., & Roper, J. A. (2023). Characterization of initial ankle-foot prosthesis prescription patterns in U.S. Service members following unilateral transtibial amputation. Frontiers in Rehabilitation Sciences, 4, 1235693. https://doi.org/10.3389/fresc.2023.1235693

Ankle-foot prosthesis prescription is a challenging and complex process, compounded by the abundance of commercially available options and lack of evidence to guide optimal device selection. This retrospective study examined the initial-ankle-foot prescription in 174 service members with transtibial amputation at Walter Reed National Military Medical Center with the goal of gaining further understanding of initial device selection. Time between injury and amputation, time between amputation and initial prescription, gender, and etiology, had an impact on initial prescription. Our findings suggest that younger service members are more likely to initially receive an energy storing and return-non articulating prosthesis, whereas a shorter time between injury and amputation and a non-combat blast injury increase the likelihood of receiving an energy storage and return-articulating prosthesis. Future work will evaluate subsequent prosthetic use and long-term outcomes.

Motherwell, J. M., Dolan, C. P., Kanovka, S. S., Edwards, J. B., Franco, S. R., Janakiram, N. B., Valerio, M. S., Goldman, S. M., & Dearth, C. L. (2023). Effects of adjunct antifibrotic treatment within a regenerative rehabilitation paradigm for volumetric muscle loss. International Journal of Molecular Sciences, 24(4), 3564. https://doi.org/10.3390/ijms24043564

Anti-fibrotic agents are potential therapies to improve outcomes following volumetric muscle loss. This study evaluated if a synergistic effect can be elicited between an antifibrotic intervention (Losartan) and rehabilitation exercise. Surprisingly, Losartan treatment did not reduce fibrosis or improve muscle function in mixed muscle graft treated VML injuries. These findings suggest that Losartan would be unsuccessful as an adjunct therapy following VML injury.

Pontillo, M., Gunterstockman, B. M., Mauntel, T. C., & Farrokhi, S. (2023). The association between kinesiophobia and functional limitations in service members with knee pain. Musculoskeletal Science & Practice, 65, 102766. https://doi.org/10.1016/j.msksp.2023.102766

This study aimed to determine the prevalence of kinesiophobia (fear of physical movement) in U.S. military service members with knee pain across different knee diagnoses, and to determine the relationships between kinesiophobia and lower extremity functional limitations. The majority of service members in this study exhibited high levels of kinesiophobia which resulted in poorer self-reported functional scores and performance in functional tasks. This study highlights the need to not only address physical findings, but also identify and address individuals with kinesiophobia.

Roach, M. H., Aderman, M. J., Ross, J. D., Kelly, T. F., Malvasi, S. R., Posner, M. A., Svoboda, S. J., Pasquina, P. F., & Cameron, K. L. (2023). Risk of upper extremity musculoskeletal injury within the first year after a concussion. Orthopaedic Journal of Sports Medicine, 11(5), 23259671231163570. https://doi.org/10.1177/23259671231163570

Three-hundred-and-sixteen United States Military Academy cadets who sustained a concussion were compared to 316 non-concussed cadets. Concussed individuals were more than twice as likely to sustain an acute upper extremity musculoskeletal injury within the first 12 months after unrestricted return to activity when compared with non-concussed matched controls. This study demonstrates results consistent with a previous study on concussion and lower extremity injury and further demonstrates the need to understand the mechanism behind this increased risk so mitigation strategies can be developed.

Roach, M. H., Bird, M. B., Helton, M. S., Carver, J. L., & Mauntel, T. C. (2023). Musculoskeletal injury risk stratification: A traffic light system for military service members. Healthcare (Basel), 11(12). https://doi.org/10.3390/healthcare11121675

This retrospective study of 2,520 service members was conducted using an existing 16-item, self-reported musculoskeletal injury risk assessment questionnaire and MSKI data from the Military Health System. Nine of the questionnaire items were associated with increased risk of experiencing an MSKI. To characterize MSKI risk a traffic light (green, amber, red) classification system was created service members characterized as red were 4.5 times as likely to sustain an MSKI than those categorized as green. As this system matures, this simple and efficient tool can be used to identify and then mitigate risk of MSKIs in Service members.

Ruxin, T. R., Halsne, E. G., Hafner, B. J., Shofer, J., Hansen, A. H., Childers, W. L., Caputo, J. M., & Morgenroth, D. C. (2023). The development of rating scales to evaluate experiential prosthetic foot preference for people with lower limb amputation. PM&R. 2023 Jun 17. https://doi.org/10.1002/pmrj.13024

This multi-site, randomized, blinded, cross-over study describes the development of activity-based standardized rating assessment scales to determine patient prosthetic foot preference more effectively. The results demonstrate that more challenging activities (i.e., incline walking, walking at fast speeds, walking upstairs) resulted in greater perceived differences across commercial feet when compared to less challenging activities. These findings demonstrate the importance of including a range of activities when prescribing prosthetic feet.

Sheehan, R. C., Guerrero, N., Wilson, J. B., Zai, C. Z., Kingsbury, T. D., Tullos, M. L., Acasio, J. C., Mahon, C. E., Miller, E., Hendershot, B. D., Dearth, C. L., Grabiner, M. D., & Kaufman, K. R. (2022). Common fall-risk indicators are not associated with fall prevalence in a high-functioning military population with lower limb trauma. Clinical Biomechanics (Bristol, Avon), 100, 105774. https://doi.org/10.1016/j.clinbiomech.2022.105774

Persons with lower limb trauma are at high risk for falls. This study examined if commonly used measures to assess fall risk can effectively predict fall risk in a younger military population. Twenty-one service members with lower limb trauma completed a battery of fall-risk assessments and gait parameters and were evaluated for a 4-week period for stumbles and falls. Despite the high number of reported falls, none of the common fall-risk indicators were associated with fall prevalence in this population.

Schmied, E. A., Boltz, J., Levine, J. A., Koenig, H., Forbang, N., Shero, J., Dearth, C. L., & Thomsen, C. J. (2023). All-cause and cause-specific mortality rates after severe extremity injuries among previously deployed active duty service members. PM&R, 15(10), 1300–1308. https://doi.org/10.1002/pmrj.12954

The current study investigates whether service members who sustain severe extremity trauma (with or without amputation) have higher mortality after their initial injury. To answer this question, a retrospective study of service members who sustained severe extremity trauma from 2001 to 2016 was conducted. The results showed that service members with severe extremity trauma which resulted in amputation had a 3-fold higher mortality rate, and service members with severe extremity trauma that didn’t result in amputation had a 2-fold higher mortality when compared to other service members with a history of deployment. This study highlights the need for future investigation into risk factors resulting in the increased mortality of service members with severe extremity trauma so mitigation strategies can be developed.

Sions, J. M., Seth, M., Beisheim‐Ryan, E. H., Hicks, G. E., Pohlig, R. T., & Horne, J. R. (2023). Adults with lower‐limb amputation: Reduced multifidi muscle activity and extensor muscle endurance is associated with worse physical performance. Clinical Physiology and Functional Imaging, 43(5), 354-364. https://doi.org/10.1111/cpf.12833

This study investigated relationships between trunk muscle function and performance-based mobility among 39 adults with a lower-limb amputation. The results indicated deficits in multifidi muscle activity and extensor muscle endurance among adults with a lower-limb amputation as compared to the general population. As trunk muscle deficits were associated with Timed Up and Go, Berg Balance Scale, and 10-meter Walk Test performance, findings suggest multifidi activity and extensor muscle endurance may be critical targets of rehabilitation to enhance mobility outcomes following amputation.

Valerio, M. S., Edwards, J. B., Dolan, C. P., Motherwell, J. M., Potter, B. K., Dearth, C. L., & Goldman, S. M. (2023). Effect of targeted cytokine inhibition on progression of post-traumatic osteoarthritis following intra-articular fracture. Int J Mol Sci, 24(17). https://doi.org/10.3390/ijms241713606

Intra-articular fractures can lead to prolonged inflammation and a 20-fold increase in the risk of developing post-traumatic osteoarthritis. This study tested the effects of a tumor necrosis factor – alpha inhibitor and an interleukin-1 receptor antagonist on IAF healing in rats. Because of significant negative side-effects in the initial phases of the study, INX was determined to be unsuitable for IAF treatment. While the IL-1 receptor antagonist ANR reduced pro-inflammatory markers, osteochondral degradation, and improved bones density, there was no significant improvement in macroscopic pathology using OARSI scoring, and glycosaminoglycan content decreased. These findings indicate that targeted inhibition of cytokines, particularly IL-1 may reduce the inflammatory response triggered by IAF; however, the extent of damage in this IAF model might have overwhelmed some of the beneficial effects of inhibiting IL-1.

Valerio, M. S., Pace, W. A., Dolan, C. P., Edwards, J. B., Janakiram, N. B., Potter, B. K., Dearth, C. L., & Goldman, S. M. (2023). Development and characterization of an intra-articular fracture mediated model of post-traumatic osteoarthritis. Journal of Experimental Orthopaedics, 10(1), 68. https://doi.org/10.1186/s40634-023-00625-9

This study describes the development of a rat model that can be used to evaluate interventions to treat post-traumatic osteoarthritis.