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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.

Snapping scapula syndrome is a rare condition that presents with symptoms ranging from crepitus to disabling pain in the scapulothoracic articulation. This condition may be more frequent in a military population because of physical fitness standards that require nonphysiologic forces to be applied to the scapulothoracic articulation. Nonoperative therapy is the first-line management. Surgical options include arthroscopic or open scapulothoracic bursectomy with or without partial scapulectomy. After scapulothoracic arthroscopy up to 90% of patients report good/excellent results, up to 90% are able to return to work, and more than 60% return to sports.

To determine the return to active duty rate of military service members undergoing lower extremity limb salvage while using a novel custom orthosis and specialized rehabilitation compared with those receiving a novel custom orthosis alone.

To define the anatomic “safe zone” for placement of external fixator half pins into the anterior and lateral femur.

Background:The optimal surgical exposure to the posterior ankle for trauma and reconstruction is a source of debate. We hypothesized that the Achilles tendon-splitting approach would provide greater exposure to the posterior ankle than the posterolateral approach. Methods:Forty surgical approaches were performed from twenty fresh-frozen cadavers. Achilles tendon-splitting and posterolateral approaches were performed using a randomized crossover design for surgical sequence. Six landmarks (medial malleolus, ankle joint, subtalar joint, incisura fibularis, lateral malleolus and medial gutter) were identified by direct visualization or palpation. A calibrated digital photograph was taken and Image J (http://rsb.info.nih.gov/ij/) was used to calculate the surface area of the distal tibia and talus exposed in neutral and dorsiflexion. Results:Using a posterolateral approach, the average distal tibia exposed was 11.3cm2in neutral and 10.2 cm2in dorsiflexion. The average talus exposed was 2.0 cm2in neutral and 2.4 cm2in dorsiflexion. Using an Achilles tendon-splitting approach, the average exposed distal tibia was 33% more (15.0 cm2) in neutral and 43% more (14.6 cm2) in dorsiflexion. The average talus exposed was 47% more (3.0 cm2) in neutral and 76% more (4.2 cm2) in dorsiflexion. All increases in exposure were statistically significant. The medial malleolus was visualized in 19 tendon-splitting and six posterolateral approaches. The medial gutter was visualized in 20 tendon-splitting and 13 posterolateral approaches. These differences were statistically significant. All other landmarks could be visualized through both approaches. Conclusion:The Achilles tendon-splitting approach provided significantly greater exposure of the posterior distal tibia and talus compared to the posterolateral approach. Clinical Relevance:Prospective studies will help determine if the tendon-splitting approach is a safe and clinically useful approach for surgeries in which direct access to the entire posterior ankle and subtalar joint are required.

Many wounded warriors experienced high-energy lower-extremity trauma (HELET) that may be limb threatening. Volumetric muscle loss, posttraumatic osteoarthritis, nerve injuries, and pain may severely limit physical function. Several wounded warriors express a strong desire to return to their units and be deployed in their original military occupational specialty. We began the return-to-run (RTR) clinical pathway at our institution 2 years ago to facilitate high-performance goals such as these. It involves an energy storing ankle foot orthosis, the intrepid dynamic exoskeletal orthosis in combination with high-intensity, progression-oriented rehabilitation. We sought to determine the rate of deployment or predeployment training after participation in this noninvasive intervention.

The ability to return to running and sports participation after lower extremity limb salvage has not been well documented previously. Although the ability to ambulate without pain or assistive devices is generally a criteria for a good limb salvage outcome, many patients at our institution have expressed a desire to return to a more athletic lifestyle to include running and sports participation. The purpose of this study was to investigate the types of athletic endeavors our high-energy lower extremity trauma patients were able to pursue after limb salvage.