Novel 3D MRI-based volumetric assessment of rotator cuff musculature demonstrates stronger correlation with preoperative functional status when compared to the Goutallier grading scheme.

Background: The Goutallier classification (GC) is used to assess fatty atrophy in rotator cuff (RC) tears, yet limitations exist. A battery of 3-dimensional (3D) magnetic resonance imaging (MRI) volumetric scores (VSs) was developed to provide comprehensive characterization of RC pathology. The purposes of this study were to (1) describe the correlation between GC and VSs for supraspinatus changes in RC tears, (2) characterize the chronicity of RC tears using a battery of 12 VS measurements, and (3) compare GC and VSs to determine which method most closely corresponds with preoperative patient-reported outcome measures (PROMs).

Objective analysis of partial three-dimensional rotator cuff muscle volume and fat infiltration across ages and sex from clinical MRI scans.

Objective analysis of rotator cuff (RC) atrophy and fatty infiltration (FI) from clinical MRI is limited by qualitative measures and variation in scapular coverage. The goals of this study were to: develop/evaluate a method to quantify RC muscle size, atrophy, and FI from clinical MRIs (with typical lateral only coverage) and then quantify the effects of age and sex on RC muscle. To develop the method, 47 full scapula coverage CTs with matching clinical MRIs were used to: correct for variation in scan capture, and ensure impactful information of the RC is measured.

Consensus and Equipose in the Management of Military Trainee Femoral Neck Stress Fractures: A Survey of Military Surgeons.

Background: Femoral neck stress fractures (FNSFs) are a unique injury pattern not commonly treated in the civilian trauma population; however, it is particularly high with military trainees engaged in basic combat training. To date, no study has surveyed a population of military orthopedic surgeons on treatment preferences for military service members (SMs) with FNSF.

Questions: We aim to evaluate the extent of clinical equipoise that exists in the management of these injuries, hypothesizing that there would be consensus in the factors dictating surgical and non-surgical intervention for FNSF.

A Deep Learning Algorithm for Automatic 3D Segmentation of Rotator Cuff Muscle and Fat from Clinical MRI Scans.

The authors aimed to develop and validate an automated artificial intelligence (AI) algorithm for three-dimensional (3D) segmentation of all four rotator cuff (RC) muscles to quantify intramuscular fat infiltration (FI) and individual muscle volume. The dataset included retrospectively collected RC MRI scans in 232 patients (63 with normal RCs, 169 with RC tears). A two-stage AI model was developed to segment all RC muscles and their FI in each stage.

An Updated Review of Improvised Ground Evacuation Platforms for Austere Special Operations Casualty Transport.

Introduction: In 2018, the Expeditionary Resuscitative Surgical Team 3 (ERST-3) published a retrospective review on the ground casualty evacuation (CASEVAC) options available to a Special Operations Forces (SOF) unit in the Horn of Africa. Seventeen months following their deployment, ERST-7 provided an update on the improvised ground evacuation platforms in the same area of operations and what has and has not worked based on combat experience and new literature.

Methods: This publication is an update to a retrospective review of various modes of ground transportation used by ERST-7 during their deployment with Special Operations Command Africa from July 2020 to January 2021.

Magnetic resonance imaging does not reliably detect Kaplan fiber injury in the setting of anterior cruciate ligament tear.

Purpose: There has been a continued effort to better understand the role Kaplan fiber injury plays in persistent instability following ACL tears. However, the prevalence of these injuries remains poorly understood. Therefore, the purpose of this study was to define the prevalence of Kaplan fiber injury in the setting of complete anterior cruciate ligament tear using a commonly used grading system for assessing ligament injuries.

Traumatic Enthesophyte From a Chronic Pectoralis Major Tendon Rupture: A Case Report.

Case: A 24-year-old active duty soldier with a chronic pectoralis major tendon rupture presented a year later with a bony lesion consistent with an enthesophyte at the humeral insertion. The patient continued to have pain that was affecting his activities of daily living and underwent surgical intervention.

Conclusion: Operative management with enthesophyte excision and pectoralis major tendon repair provided relief to the patient's symptoms and return to preinjury levels of function as evaluated with Tegner, single assessment numeric evaluation, and visual analog scale scores at the 2-year follow-up.

Parachute-Induced Pectoralis Major Tears in Military Servicemembers: What Is the Functional Recovery?

Background: Although the most common injury mechanism for pectoralis major (PM) tears is an eccentric loading mechanism typically caused by bench pressing, within the military, there is a unique injury mechanism associated with airborne operations. The results of operative repair for these parachute-induced PM tears have not been previously reported.

Purpose/hypothesis: To assess the functional outcomes in military servicemembers undergoing operative repair of parachute-induced PM tears.

Primary ACL Repair of a Chronic ACL Femoral Avulsion with 2-Year Clinical and Radiographic Outcomes: A Case Report.

Case: There has been a reemergence of anterior cruciate ligament (ACL) repair. We present the unique case of an ACL repair in a service member with a chronic tear. The patient went on to have a successful outcome with return to full activities without symptoms and functional outcomes scores equal to preinjury levels.

Treatment of a Combined Pectoralis Major Tear, Anterior Labral Tear, and Humeral Avulsion of the Glenohumeral Ligament (HAGL) in an Active Duty Soldier.

Anterior glenohumeral instability is an increasingly common injury among young military servicemen. First-time dislocations occurring in combination with anterior labral tears and humeral avulsion of glenohumeral ligament lesions, although rare, significantly contribute to further shoulder dysfunction with recurrent instability and pain. Tears of the pectoralis major are also a type of injury more common in the military population, with operative management resulting in decreased strength.

Likelihood of Return to Duty Is Low After Meniscal Allograft Transplantation in an Active-duty Military Population.

Background: Meniscal allograft transplantation (MAT) is considered a viable surgical treatment option in the symptomatic, postmeniscectomy knee and as a concomitant procedure with ACL revision and articular cartilage repair. Although promising outcomes have recently been reported in active and athletic populations, MAT has not been well-studied in the high-demand military population.

Questions/purposes: (1) What proportion of active-duty military patients who underwent MAT returned to full, unrestricted duty? (2) What demographic and surgical variables, if any, correlated with return to full, unrestricted duty?

Methods: Between 2005 and 2015, three fellowship-trained sports surgeons (TMD, SJS, BDO) performed 110 MAT procedures in active-duty military patients, of which 95% (104 patients) were available for follow-up at a minimum 2 years (mean 2.

Isolated tears of the sternocostal head of the pectoralis major muscle: surgical technique, clinical outcomes, and a modification of the Tietjen and Bak classification.

Hypothesis: We aimed to describe a modified surgical technique to treat isolated sternocostal head tears using cortical button fixation while preserving the intact clavicular head tendon, to outline a new classification of pectoralis major injuries, and to present the clinical outcomes and return-to-sport data of a cohort of 21 athletes who underwent surgical repair.

Methods: We reviewed prospectively collected data of patients who underwent surgical repair with the described technique for isolated sternocostal head tears from 2008 to 2014. Two-year postoperative clinical outcomes including the Single Assessment Numeric Evaluation score, isokinetic strength, patient satisfaction, and return to sport, as well as preinjury and postoperative bench-press weight, were collected, and descriptive statistics were used for analysis.

Magnetic Resonance Imaging Correlates With Computed Tomography for Glenoid Version Calculation Despite Lack of Visibility of Medial Scapula.

Purpose: To assess the accuracy of measuring glenoid version on magnetic resonance imaging (MRI) in the presence of varying amounts of the medial scapula body as compared with the gold standard of glenoid version measured on computed tomography (CT) imaging, including the entire scapula in a cohort of young patients with shoulder instability and without glenohumeral arthritis.

Methods: A retrospective review was performed on instability patients with preoperative MRI and CT imaging. Measurements of available scapular width and glenoid version were performed using the Cobb angle method to measure the angle between the plane of the glenoid fossa to Friedman's line on axial images.

Joint Space Narrowing in Patients with Femoroacetabular Impingement: A Matched Cohort Study of Military versus Civilian Patients.

Introduction: Decreased hip joint space has been associated with poorer outcomes after hip arthroscopy. The purpose of this study was to determine if a difference exists in hip joint degenerative findings in military versus civilian patients with FAI.

Methods: A single surgeon's case series was reviewed to identify all patients undergoing primary hip arthroscopy for treatment of FAI.

Outcomes of Pectoralis Major Tears in Active Duty US Military Personnel: A Comparison of Surgical Repairs Performed in the Forward Deployed Setting to Those Performed in the Continental United States.

Introduction: The purpose of our study is to compare pectoralis major tears in active duty military personal repaired surgically in the forward deployed setting to those performed in the Continental United States.

Materials And Methods: Retrospective comparison of all pectoralis major tendon repairs performed at Madigan Army Medical Center from 2000 to 2007 to a forward deployed series treated by two deployed United States Air Force orthopedic surgeons at one expeditionary medical treatment facility over a 4-month deployment cycle from December 2013 through March 2014.

Results: Fourteen patients from the CONUS group and eight patients from deployed group were compared; they had a mean age of 32 years (21-52) all with pectoralis major ruptures that underwent operative fixation.

Improvised Ground Evacuation Platforms for Austere Special Operations Casualty Transport.

There are no established ground medical-evacuation systems within Special Operations Command Africa (SOCAFRICA), given the austere and varied environments. Transporting the injured casualty requires ingenuity and modification of existing vehicles. The Expeditionary Resuscitative Surgical Team (ERST) assigned to SOCAFRICA used four unconventional means for ground evacuation.

Tibial Interference Screw Positioning Relative to the Bone Plug in ACL Reconstruction: A Biomechanical Comparison of Cortical Versus Cancellous-Sided Placement.

The biomechanical strength of a bone-patellar tendon-bone graft in the tibia may vary depending on whether the interference screw abuts the cancellous vs the cortical surface of the bone plug. In a porcine model, 10×20-mm bone-patellar tendon-bone grafts were prepared and fixed in a 10-mm diameter tibial tunnel using a 9×25-mm titanium interference screw. The screw was positioned on the cancellous surface of the graft in group A (n=13) vs the cortical side of the graft in group B (n=14).

Change in KOOS and WOMAC Scores in a Young Athletic Population With and Without Anterior Cruciate Ligament Injury.

Background: Several studies have examined changes in patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) injury, but no studies to date have prospectively evaluated changes from preinjury baseline through injury and follow-up among ACL-injured patients compared to the baseline and follow-up changes of uninjured patients.

Purpose: To examine changes in PROMs over time from preinjury baseline to at least 2 years after ACL reconstruction and to compare these changes with those of an uninjured control group having similar physical activity requirements.

Study Design: Cohort study; Level of evidence, 2.

Return to Military Duty After Anterior Cruciate Ligament Reconstruction.

Background: Return to play and risk factors for functional limitations have been widely reported among athletes following anterior cruciate ligament reconstruction (ACLR) but has not been well studied in the military population.

Methods: We conducted a retrospective review of all active duty service members who underwent primary ACLR at our institution between 2005 and 2010. The primary endpoints evaluated included Medical Evaluation Board (MEB) and activity limitations as noted by permanent profile (PP) following surgery.

Posterior Shoulder Instability.

Context: Posterior shoulder instability has become more frequently recognized and treated as a unique subset of shoulder instability, especially in the military. Posterior shoulder pathology may be more difficult to accurately diagnose than its anterior counterpart, and commonly, patients present with complaints of pain rather than instability. "Posterior instability" may encompass both dislocation and subluxation, and the most common presentation is recurrent posterior subluxation.

Magnetic resonance imaging evaluation of adjacent segments after cervical disc arthroplasty: magnet strength and its effect on image quality. Clinical article.

Object: Disc arthroplasty is an alternative to fusion following anterior discectomy when treating either cervical radiculopathy or myelopathy. Its theoretical benefits include preservation of the motion segment and the potential prevention of adjacent-segment degeneration. There is a paucity of data regarding the ability to use MR imaging to evaluate the adjacent segments.

Pectoralis major tendon repairs in the active-duty population.

Rupture of the pectoralis major tendon is an uncommon injury that typically occurs in young, active people. Of this injury population, active-duty military personnel represent a unique, athletic subset that is commonly treated with operative repair. For the retrospective case series reported here, we hypothesized that active-duty soldiers with acute and chronic pectoralis major tendon ruptures treated with operative repair would have high levels of patient satisfaction, quick return to work and sports, and few long-term complications.