Grant program backing research on orthopaedic combat injuries loses funding

In fiscal year (FY) 2009, the Department of Defense’s Congressionally Directed Medical Research Programs (CDMRP) established the Peer Reviewed Orthopaedic Research Program (PRORP) with an initial congressional investment of $112 million. Since 2012, PRORP has been a competitive, annual $30 million grant program that funds basic and clinical research on orthopaedic combat injuries, including amputee rehabilitation and trauma research. As one of the most successful programs under CDMRP, enrolling more than 15,000 patients in studies to date, the PRORP was eliminated completely after a 57% cut to CDMRP’s budget this year, despite bipartisan support for the program.

PRORP funding has supported 355 research awards that have helped advance treatment and rehabilitation for military personnel and civilians who suffer from orthopaedic injuries. Around 78% of male and 85% of female service members separate from active duty due to a disability resulting from a musculoskeletal injury or condition.

“When I became president of AAOS in 2005, we learned how our men and women on active duty were being maimed by improvised explosive devices, and we needed to figure out how to treat these injuries to bone and muscle that we’d never seen before,” said Stuart Weinstein, MD, orthopaedic surgeon at University of Iowa Physicians and past president of AAOS and the Political Action Committee of the American Association of Orthopaedic Surgeons. “We were able to work with Congress and the Department of Defense to secure research funding to address these problems, helping those in the military and eventually applying those learnings to the civilian trauma population. This is a white-hat issue that affects all men and women in the military who we ask to put their lives on the line. PRORP is a minimal monetary investment with a huge return on that investment, not only for our active duty military personnel but for all Americans. Not seeing this as beneficial is a real crime. The advancements we have seen in so many areas, including in orthotics and prosthetics, are because of this program.”

PRORP addresses significant gaps in care
During Operation Iraqi Freedom and Operation Enduring Freedom, most combat injuries involved extremity injuries and orthopaedic-specific conditions secondary to battle injuries, representing the largest cause of long-term disability for returning service members. Blast and other combat-related orthopaedic injuries are complicated, involving multiple tissues, including skin, bone, muscle, cartilage, and nerves. Many of these injuries are multiple limb traumas not seen in the civilian population and are sustained in a setting where access to optimal acute care is difficult. The complications can include amputation, infection, compartment syndrome, nonunion of the bone, heterotopic ossification, and temporary or permanent functional muscle loss.

In the civilian population, 70% of musculoskeletal injury patients report lost workdays, which has a significant impact on the economy in addition to the $176.1 billion per year cost to treat these injuries. CDMRP established PRORP to reduce the burden of these types of injuries for military members and civilians by funding high-risk, high-reward research that advances patient outcomes and moves interventions into clinical practice.

The results of PRORP-funded research have altered how military personnel and civilians are treated when sustaining a musculoskeletal injury and led to breakthrough advancements, including opioid-sparing pain-management therapies, improved surgical protocols, and rehabilitation methods that are now used across orthopaedics. Some of the substantial outcomes include:

• A clinical trial found that using vancomycin, a low-cost therapy, significantly reduced the risk of surgical site infections after traumatic fractures, changing the standard of care.
• The SPRINT Peripheral Nerve Stimulation System, which is now in clinical use, was shown to relieve residual limb pain and phantom limb pain in patients with amputations, decreasing opioid use by 80% and sustaining pain relief. Over 11,000 patients have been treated commercially to date.
• An FY2012 clinical trial provided overwhelming evidence to support the use of surgical training targeted muscle reinnervation for the treatment of and prevention of nerve pain in amputees.
• Pivotal research funded in FY2013 using clinical samples of osteoarthritis tissues changed the current understanding of the mechanisms and biochemical environment of osteoarthritis onset.
• The NU-FlexSIV socket was developed and validated through PRORP-funded research in FY2009 and FY2014 and is now available in clinical settings to support mobility in unilateral transfemoral amputees.

“The work that has been done with the PRORP funds has been spectacular,” said Andrew N. Pollak, MD, chief clinical officer of the University of Maryland Medical System and former chair of AAOS’ Extremity War Injuries Project Team. “We have put together the largest consortium of trauma orthopaedic research in the world. Within that consortium, we have enrolled more patients in prospective, randomized trials than has ever been done before. We have translated that into hundreds of millions of grant dollars to investigate problems that are immediate threats to our men and women in the fighting forces, as well as to people in the civilian sector. The idea that we are going to slow down that progress now seems completely counter to what the investments in Defense Department research are intended to do. This work immediately impacts our military personnel. It delivers care that allows them to lead functional lives and contribute to society as a whole.”

PRORP funding cut for FY2026
For more than a decade, PRORP has supported orthopaedic research, including early in vitro and in vivo research; applied research in animal models; pilot human subjects clinical research; and randomized, controlled clinical trials. With the extreme success of PRORP, the program has received broad support across the aisle over the years and has been fully funded. However, with the CDMRP’s budget cut by 57% as part of the March 2025 Continuing Resolution, funding for PRORP was completely eliminated.

The House recently passed out of committee a version of the Defense appropriations bill (H.R. 4016) that partially restores funding for PRORP at $15 million for FY2026—half its historical funding level. Underfunding PRORP threatens to halt innovative research that has helped active military personnel, veterans, and civilians receive optimal treatment and rehabilitation for musculoskeletal injuries, ensuring they can lead functional and productive lives.

AAOS has joined forces with numerous orthopaedic professional groups, including the Orthopaedic Research Society, the Society of Military Orthopaedic Surgeons, and the Orthopaedic Trauma Association, to ask Congress to fully restore funding for PRORP for FY2026. AAOS has elevated this issue to Tier I in the Unified Advocacy Agenda, developing a grassroots campaign for members to reach out to their senators. AAOS members can send a pre-drafted letter to their senators through the Advocacy Action Center.

“This issue deserves 100% attention from our members,” Dr. Weinstein said. “As a professional association, we need to show our members of Congress how important this is to us by sending letters and reaching out. We need to take up the cry for this as no one else will; it is an ‘orthopaedic issue.’ We need to put pressure on Congress to fund PRORP and help our injured military men and women get the care they deserve.”

Molly Todd Rudy is a freelance writer for AAOS Now.