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AAOS Now

Published 2/1/2016
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Andrew J. Sheean, MD

Studies on ACL-Deficient Knees, and More Receive Awards

The Society of Military Orthopaedic Surgeons (SOMOS) honored research on the use of local antibiotics in contaminated open fractures, as well as on anterior cruciate ligament (ACL) deficiency in knees and chronic exertional compartment syndrome of the lower leg at its 2015 annual meeting, held Dec.7–11, 2014, in St. Petersburg, Fla. The CDR Michael T. Mazurek Clinician Scholar Award and the COL Brian Allgood Memorial Leadership Award were also presented.

In addition, attendees had the opportunity to choose from scientific programming on a wide range of topics, such as rehabilitation following lower extremity trauma, treatment of complications in open forearm fractures in pediatric patients, and management of complex elbow injuries.

Award-winning research
The Founder's Award, which recognizes the best original paper with military relevance, went to CPT David J. Tennent, MD, for his work examining the efficacy of local antibiotics in contaminated open fractures. Dr. Tennent's coauthors on "Decreasing Infection in Traumatic Orthopaedic Wounds with Local Antibiotics: A Contaminated Fracture Model" included Stefanie Shiels, PhD; Carlos J. Sanchez, Jr, PhD; MAJ Kevin Akers, MD; MAJ Daniel J. Stinner, MD; Krista Niece, PhD; and Joseph C. Wenke, PhD.

The researchers, who compared the effectiveness of locally applied antibiotic powder and antibiotic-loaded polymethylmethacrylate (PMMA) beads in a contaminated traumatic animal model at different time points, found that "early local application of antibiotic powder is a promising adjunct for preventing infection in traumatic wounds." They added, however, that "the inability of vancomycin to overcome biofilms, which is likely consequent to its mechanism of action, limits its use in cases where established infections are suspected or treatment is excessively delayed."

The Norman T. Kirk Award, which is given to the best scientific paper by a military orthopaedic resident, was given to LCDR Lucas S. McDonald, MD, MPH, TM, for his biomechanical investigation of effects of ACL-deficient knees, "ACL-Deficiency Alters Loading on the Medial Femoral Condyle and the Lateral Meniscus with Rotary Loads." Dr. McDonald's co-authors included Andrew D. Pearle, MD; James Boorman-Padgett, BS; Kyle E. Stone, MS; Thomas L. Wickiewicz, MD; and Carl W. Imhauser, PhD.

The investigators conducted the study to quantify loads borne by the isolated medial and lateral femoral condyles and menisci in the ACL-competent and ACL-deficient knee during rotational stability testing. They determined that sectioning the ACL increased loads on the lateral meniscus and on the medial femoral condyle, while loads borne by the medial meniscus and the lateral femoral condyle "remained small and unchanged in response to combined torques after sectioning the ACL." They concluded that the distinct loading patterns they identified "provide biomechanical rationale for clinical patterns of intra-articular derangement seen with acute and chronic ACL insufficiency, including lateral meniscus damage and osseous remodeling of the medial compartment."

MAJ Jeanne Patzkowski, MD, received the CDR Michael T. Mazurek Clinician Scholar Award, which recognizes a SOMOS member who has most notably demonstrated the potential and desire to become an orthopaedic clinician scholar. Dr. Patzkowski recently completed the John A. Feagin Jr. Sports Medicine Fellowship at the United States Military Academy and is currently stationed at Tripler Army Medical Center, Honolulu, HI, where her current research interests include shoulder instability in military trainees, multiligamentous knee injuries, and the prevention of posttraumatic osteoarthritis.

The Louise Howard Award, which recognized the best original poster presentation with military relevance went to CPT Nicholas A. Kusnezov, MD, for "Chronic Exertional Compartment Syndrome of the Lower Leg: A Systematic Review." Dr. Kusnezov's coauthors included Dominic Campano, BA; Jose Robaina,  Jr, BS; CPT John C. Dunn, MD; and MAJ Brian R. Waterman, MD. This systematic review of the literature found that, according to the authors, primary operative management of chronic exertional compartment syndrome yields "moderately successful clinical outcomes with an acceptably low risk of reoperation and perioperative complications."

In addition to recognizing the scholarly achievements of its members, SOMOS also recognized COL (Ret) B. Hudson Berrey, MD, FACS, with the COL Brian Allgood Memorial Leadership Award—the Society's highest honor—for leadership excellence in military orthopaedic surgery. Dr. Berrey was honored as the individual who best exemplified COL Allgood's attributes of selfless leadership, commitment to excellence in military orthopaedics, and loyalty to "Duty, Honor, Country."

Scientific program and special speakers
Program Co-Chairs Maj Matthew R. Schmitz, MD, FAAP, and MAJ Travis C. Burns, MD, designed an educational program focused on surgical and nonsurgical military orthopaedic care that featured high-quality scientific posters and papers, as well as symposia and several notable roundtable discussions.

One study of interest was "Post-Operative Blood Flow Restriction Training Following Knee Arthroscopy: A Randomized, Controlled Trial." The study, conducted by Dr. Tennent as well as CPT Christina M. Hylden, MD; LTC(P) Anthony E. Johnson, MD; MAJ Travis C. Burns, MD; Jason M. Wilken, PhD, PT; and Johnny Owens, PT, investigated the efficacy of the use of Blood Flow Restriction (BFR) training as a therapeutic adjunct after nonreconstructive knee arthroscopy. The investigators found that patients in the BFR group and the control group had significant improvements in VR-12 physical component scores, and that the BFR group had significant changes in the VR-12 mental component scores and larger changes in thigh girth compared to controls. According to the researchers, the results of this randomized, controlled pilot study suggest that "BFR as a postoperative therapeutic adjunct is safe and effective."

In addition, educational programming included a number of informative lectures and scientific presentations during the Warren Kadrmas Memorial Sports Day, during which Arthroscopy Association of North America (AANA) President William R. Beach, MD, reaffirmed the collaborative, synergistic partnership between AANA and SOMOS, and provided an in-depth review of current trends in the surgical management of patellar instability. New to this year's program, four Rapid Fire concurrent academic sessions focused on a specialized topic for smaller groups to break down and concentrate on areas of particular interest. Topics included for in-depth discussions included recurrent glenohumeral instability among military trainees, postoperative ACL reconstruction rehabilitation protocols, and the role of osteotomies about the knee for lateral compartment arthrosis and patellofemoral maltracking. 

The Team Physician Roundtable, led by Dr. Schmitz (U.S. Rugby), included Lt Col Dain Allred, MD (U.S. Air Force Academy), CDR (Ret) Matthew T. Provencher, MD (New England Patriots), CDR John-Paul H. Rue, MD (U.S. Naval Academy), COL Steven J. Svoboda, MD (U.S. Military Academy), and AAOS President David D. Teuscher, MD. The roundtable offered insights into some of the more salient issues facing team physicians, including roundtable participants' views on the management of sports-related concussion, uncontrolled and controlled medication prescribing, and the logistics of treating athletes while removed from one's home facilities.

Dr. Teuscher also addressed SOMOS attendees regarding medicolegal trends affecting orthopaedic surgeons, and presented tips for surgeons involved in litigation as well as the AAOS advocacy efforts.

Dr. Johnson reported on the state of SOMOS, highlighting ongoing efforts to maintain the organization's strong levels of membership amongst active duty military orthopaedic surgeons and continued efforts to expand the SOMOS Research Collaborative. This initiative promises to dramatically enhance the collection and sharing of meaningful clinical data across U.S. Department of Defense medical treatment facilities, with a focus on maintaining operational readiness and the retention of critical lessons learned in the care of our warrior population as we enter the "Inter-War Period."

Finally, Lt Col Mark A. Slabaugh, MD, became SOMOS president. Dr. Slabaugh will preside over the 58th SOMOS annual meeting in Olympic Valley, Calif., to be held Dec 12–16, 2016.

Andrew J. Sheean, MD, is a member of the AAOS Now editorial board. He can be reached at ajsheean@gmail.com