Management of acute Achilles tendon ruptures: a survey of Army orthopaedic surgeons.

Background: Despite the literature on acute Achilles tendon ruptures, there remains a lack of consensus regarding the optimal treatment. The purpose of this survey study was to investigate treatment preferences among Army orthopaedic surgeons when presented with a standardized case of an acute Achilles rupture and determine if surgeon factors correlated with treatment preference.

Methods: A hypothetical case of a 37-year-old male with history, physical exam, and imaging consistent with an Achilles rupture was sent to board-certified Army orthopaedic surgeons to determine their preferred management.

An evaluation of bariatric surgery in all military treatment facilities.

Background: Multiple bariatric databases have been formed, but there have been no comprehensive assessments of military treatment facilities (MTFs). MTFs have unique patients and coverage policies by Tricare insurance.

Methods: MHS Mart (M2) was used to review the outpatient medical record, AHLTA, from October 2013 to December 2018 for type of bariatric procedure, demographics, military-specific data, comorbidities, and complications, which were identified by ICD code and CPT code, including a robotic modifier.

Technical success rate of MR elastography in a population without known liver disease.

Purpose: MR elastography (MRE) has a low technical failure rate in patients with chronic liver disease. The failure rate in an unscreened population is unknown. The purpose of this study was to determine the technical failure rate of MRE in patients with no known liver disease.

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.

Updating the modified Thompson test by using whole-body bioluminescence imaging to replace traditional efficacy testing in experimental models of murine malaria.

Background: Rodent malaria models are extensively used to predict treatment outcomes in human infections. There is a constant need to improve and refine these models by innovating ways to apply new scientific findings and cutting edge technologies. In addition, and in accordance with the three R's of animal use in research, in vivo studies should be constantly refined to avoid unnecessary pain and distress to the experimental animals by using preemptive euthanasia as soon as the main scientific study objective has been accomplished.

Perioperative Complications After Spinal Fusion in Pediatric Patients With Congenital Heart Disease.

Background: Children with congenital heart disease (CHD) have been reported to be at increased risk of developing scoliosis following cardiac surgery. Previous sample studies have reported that these patients may safely undergo posterior spinal fusion (PSF) with low complication rates. The goal of this study is to provide an updated analysis of the perioperative complication profile for posterior spinal fusion in a large cohort of pediatric patients with CHD, using a nationwide database.

A Guide to Understanding Reimbursement and Value-Based Care in the Military Health System.

Introduction: With the continued rise in the cost of U.S. health care, there is an increased emphasis on value-based care methodologies.

Critical Care in the Military Health System: A Survey-Based Summary of Critical Care Services.

Introduction: Critical care is an important component of in-patient and combat casualty care, and it is a major contributor to U.S. healthcare costs.

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.

The Epidemiology and Natural History of Anterior Shoulder Instability.

Purpose Of Review: The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability.

Recent Findings: Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well.

Cardiac preparticipation screening for the young athlete: why the routine use of ECG is not necessary.

The addition of an electrocardiogram (ECG) to the current United States athlete preparticipation physical evaluation (PPE) as a screening tool has dominated the PPE discussion over the past decade despite the lack of demonstrable outcomes data supporting the routine use of the diagnostic study for reduction of sudden cardiac death (SCD). A good screening test should influence a disease or health outcome that has a significant impact on public health and the population screened must have a high prevalence of the disease to justify the screening intervention. While SCD is publicly remarkable and like any death, tragic, the prevalence of SCD in young athletes is very low and the potential for false positive results is high.

Effect of the degree of reverse Trendelenburg position on intraocular pressure during prone spine surgery: a randomized controlled trial.

Background Context: Postoperative vision loss complicates an estimated 1 in 1,100 prone spine surgical cases. This complication has been attributed to ischemic optic neuropathy, with one proposed reason being perioperative elevations in intraocular pressure (IOP). Previous research has studied the effects of table inclination on IOP in awake volunteers; however, the effects in spine surgery patients have not been investigated for reverse Trendelenburg positioning using a prospective, randomized controlled study design.

ACL reconstruction in a deployed environment in support of operation enduring freedom: a surgical technique.

Military orthopaedic surgeons in deployed environments along with orthopaedic surgeons working in more austere environments often find themselves without surgical equipment that they are normally accustomed to having in the operative suite. Today's U.S.

Evaluation and management of common anorectal conditions.

The prevalence of benign anorectal conditions in the primary care setting is high, although evidence of effective therapy is often lacking. In addition to recognizing common benign anorectal disorders, physicians must maintain a high index of suspicion for inflammatory and malignant disorders. Patients with red flags such as increased age, family history, persistent anorectal bleeding despite treatment, weight loss, or iron deficiency anemia should undergo colonoscopy.