Blood Flow Restriction Training After Knee Arthroscopy: A Randomized Controlled Pilot Study.

INTRODUCTION: Quadriceps strength after arthroscopic knee procedures is frequently diminished several years postoperation. Blood flow restriction (BFR) training uses partial venous occlusion while performing submaximal exercise to induce muscle hypertrophy and strength improvements. The purpose of this study was to evaluate BFR as a postoperative therapeutic intervention after knee arthroscopy. METHODS: A randomized controlled pilot study comparing physical therapy with and without BFR after knee arthroscopy was conducted. Patients underwent 12 sessions of supervised physical therapy. Subjects followed the same postoperative protocol with the addition of 3 additional BFR exercises. Outcome measures included thigh girth, physical function measures, Knee Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR12), and strength testing. Bilateral duplex ultrasonography was used to evaluate for deep venous thrombosis preintervention and postintervention. RESULTS: Seventeen patients completed the study. Significant increases in thigh girth were observed in the BFR group at 6-cm and 16-cm proximal to the patella (P = 0.0111 and 0.0001). All physical outcome measures significantly improved in the BFR group, and the timed stair ascent improvements were greater than conventional therapy (P = 0.0281). The VR-12 and KOOS subscales significantly improved in the BFR group, and greater improvement was seen in VR-12 mental component score (P = 0.0149). The BFR group displayed approximately 2-fold greater improvements in extension and flexion strength compared with conventional therapy (74.59% vs 33.5%, P = 0.034). No adverse events were observed during the study. CONCLUSIONS: This study suggests that BFR is an effective intervention after knee arthroscopy. Further investigation is warranted to elucidate the benefits of this intervention in populations with greater initial impairment.

Disability After Deployment Injury: Are Women and Men Service Members Different?

BACKGROUND: Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders. QUESTIONS/PURPOSES: (1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury? METHODS: The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject's return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries. RESULTS: Women who were unable to return to duty had a higher frequency of arthritic conditions (58% [48 of 83] of women versus 35% [133 of 378] of men, p=0.002; relative risk [RR], 1.64; 95% confidence interval [CI], 1.307-2.067) and lower frequencies of general chronic pain (1% [one of 83] of women versus 19% [59 of 378] of men, p<0.001; RR, 0.08; 95% CI, 0.011-0.549) and neurogenic pain disorders (1% [one of 83] of women versus 7% [27 of 378] of men, p=0.0410; RR, 0.169; 95% CI, 0.023-1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38%±23% versus 19%±17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p=0.003). CONCLUSIONS: After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability. LEVEL OF EVIDENCE: Level III, prognostic study.

Hydration Strategies for the Female Tactical Athlete.

With unprecedented expansion of the roles of women in the military and the longest period of continuous active combat in US history, it is time that research expanded, including the nutritional and hydration requirements of the female tactical athlete. Dehydration has a negative effect on athletic performance, most significantly in high intensity, aerobic endurance activities. There is evidence female athletes may be more prone to the potentially lethal effects of over hydration. The purpose of this article is to provide a review of the literature to ascertain optimal hydration strategies for the female tactical athlete.

A randomized controlled trial evaluating methylsulfonylmethane versus placebo to prevent knee pain in military initial entry trainees.

BACKGROUND: Methylsulfonylmethane (MSM) is a naturally occurring sulfur containing substance that has been shown to have anti-inflammatory and antioxidative properties. Previous studies using MSM as an oral supplement to improve pain in those patients with knee osteoarthritis have shown superiority compared to placebo. However, these studies are not translatable to active individuals performing high impact activities and have not evaluated MSM as a preventative measure. METHODS: A total of 180 subjects ranging in age from 18 to 40 years were enrolled. Subjects were randomized into 2 groups receiving either 3 grams OptiMSM methylsulfonylmethane (Bergstrom Nutrition, Vancouver, WA) or a placebo for 8 weeks. Outcomes measured were the Knee Osteoarthritis Outcome Score (KOOS) and the Profile of Moods States (POMS). RESULTS: Three grams of MSM administered daily did not provide significant improvements in the 5 KOOS subscales or the 6 POMS subscales at 30 days or 60 days. CONSLUSION: Although 3 grams of MSM daily can be used safely, there does not appear to be a significant improvement in KOOS or POMS.

Burnout in U.S. Military Orthopaedic Residents and Staff Physicians.

OBJECTIVE: The purpose of this study was to measure the prevalence of burnout among military orthopaedic residents and staff surgeons at the U.S. Army Medical Center. METHODS: 37 residents and 21 staff surgeons of a military orthopaedic residency program were asked to voluntarily complete an anonymous electronic survey. The survey consisted of two parts: first, a demographic section including questions about relationship status, work hours, deployment history, medical education debt, mentorship, and job satisfaction and second, the Maslach Burnout Inventory. RESULTS: 27 residents and 11 staff completed the survey for a 67% response rate. The rate of burnout among military orthopaedic surgeons in our study was 7.7% (3.7% of residents and 16.7% of staff surgeons). In addition, 25.6% of surgeons (33% of residents and 8.3% of staff) were found to be at risk of burnout. CONCLUSIONS: Future studies should focus on causal relationships among specific aspects of the work environment and possible preventive or protective measures. Expanding future studies to include multiple study sites would improve the quality and generalizability of the results.