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Feeley SM, Rodkey DL, Harrington CJ, Porter K, McMillan L, Amendola A, Slaven SE, Dickens JF. Return to Duty in Military Servicemembers After High Tibial Osteotomy Not Associated With Preoperative Radiographic Parameters : A Retrospective Analysis. Orthop J Sports Med 2024; 12:23259671241252410. [PMID: 38770030 PMCID: PMC11104033 DOI: 10.1177/23259671241252410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 05/22/2024] Open
Abstract
Background Evidence on return to sports/work after high tibial osteotomy (HTO) is limited, especially in a young, high-demand population. Purpose To (1) identify whether preoperative knee pathology or intraoperative correction was associated with successful return to duty (RTD) and (2) assess whether postoperative complications and reoperation were associated with failure to RTD. Study Design Case series; Level of Evidence, 4. Methods We performed a retrospective cohort study of a consecutive series of patients in the Military Health System aged 18 to 55 years with medial compartment osteoarthritis who underwent HTO between 2003 and 2018. Concomitant meniscal and cartilage procedures were included, while cases with concomitant ligamentous procedures were excluded. The inclusion criteria were as follows: active-duty military status, minimum 2-year follow-up, preoperative knee radiographs, and pre- and postoperative long-leg alignment radiographs. Preoperative Kellgren-Lawrence grades and pre- and postoperative hip-knee-ankle angles were measured. The primary outcome was RTD. Failure was defined as knee-related medical separation from the military or conversion to total knee arthroplasty. The secondary outcome was reoperation. Results A total of 55 HTOs were performed in 50 patients who met the inclusion criteria, with a mean age of 39 years old (range, 22.8-55 years). The mean follow-up was 5 years (range, 2.1-10.7 years). Ten knees (18.2%) failed HTO (1 conversion to total knee arthroplasty, 9 medical separations), 15 additional knees (27.3%) had permanent activity restrictions, and 30 knees (54.5%) returned to duty without restrictions. Reoperation occurred in 36.4% of knees and was associated with medical separation (P = .039). Younger age was associated with medical separation (P = .003) and permanent restrictions (P = .006). Patients with a postoperative varus deformity of >5° were more likely to undergo medical separation (P = .023). Conclusion In a young, high-demand population, HTO succeeded in returning 54.5% of knees to full duty without restriction despite 36.4% of knees requiring reoperation. Residual varus deformity or reoperation was associated with lower RTD rates. No association was identified between RTD and preoperative osteoarthritis grading or deformity.
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Affiliation(s)
- Scott M. Feeley
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Daniel L. Rodkey
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | | | - Kaitlin Porter
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Logan McMillan
- Wright-Patterson Medical Center, Wright-Patterson AFB, Ohio, USA
| | | | - Sean E. Slaven
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Yang F, Xie B, Zhang H, Li T, Mao J, Chen Z, Peng Y, Li T, Sun S, Chen J, Chen Y, Du J. Return to flight duty (RTFD) after posterior lumbar spine surgery for symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) in Chinese military pilots. BMC Musculoskelet Disord 2024; 25:81. [PMID: 38245679 PMCID: PMC10799416 DOI: 10.1186/s12891-024-07175-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Symptomatic lumbar disc herniation (LDH) and lumbar isthmic spondylolisthesis (LIS) present significant challenges for military pilots, which may result in grounding if not effectively managed. Surgical treatment for LDH and LIS may offer a pathway to return to flight duty (RTFD), but recent data on this crucial topic is lacking. This study seeks to address this gap by investigating the RTFD outcomes among Chinese military pilots who have undergone lumbar spine surgery for symptomatic LDH and LIS. METHODS A retrospective review was conducted on active-duty military pilots who underwent isolated decompressive or fusion procedures at an authorized military medical center from March 1, 2007, to March 1, 2023. The analysis utilized descriptive statistics to examine demographic, occupational, surgical, and outcome data, with a particular focus on preoperative flight status, recommended clearance by spine surgeons, and actual RTFD outcomes and time. RESULTS Among the identified cases of active-duty military pilots with LDH or LIS treated by lumbar surgery (n = 24), 70.8% (17 of 24) consistently maintained RTFD status without encountering surgical complications or medical issues during the follow-up period. Of the seven pilots who did not RTFD, one retired within a year of surgery, two had anterior cruciate ligament injuries, three had residual radicular symptoms, and one had chronic low back pain. Excluding pilots who retired and did not RTFD for reasons unrelated to their lumbar conditions, the RTFD rate stood at 81.0% (17 of 21). The median time for recommended clearance by spine surgeons was 143.0 days (inter-quartile range, 116.5-196.0), while the median duration for actual RTFD attainment was 221.0 days (inter-quartile range, 182.0-300.0). The median follow-up post-lumbar surgery was 1.7 years (inter-quartile range, 0.4-2.9). CONCLUSION Most military pilots diagnosed with symptomatic LDH and LIS can continue their careers and regain active-duty flight status following lumbar spine surgery, as reflected by the high RTFD rate. Lumbar spine surgery can successfully alleviate the physical constraints associated with spinal conditions, facilitating the return of military pilots to their demanding profession.
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Affiliation(s)
- Fengyuan Yang
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Bowen Xie
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- The Fifth School of Clinical Medicine, Air Force Clinical College, Anhui Medical University, Anhui, 230032, China
| | - Hongxing Zhang
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Tianqi Li
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Jian Mao
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Zhiqiang Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China
| | - Ye Peng
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Tengfei Li
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Siguo Sun
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Jingyang Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China
| | - Yufei Chen
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China.
| | - Junjie Du
- Department of Orthopedics, Air Force Medical Center of PLA, Beijing, 100142, China.
- Graduate School of Medicine, China Medical University, Shenyang, 110122, China.
- The Fifth School of Clinical Medicine, Air Force Clinical College, Anhui Medical University, Anhui, 230032, China.
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Galvin JW, Slevin JM, Nowak MJ, Yu HH, Turner EK, Waterman BR, Grassbaugh JA, Arrington ED. A High Rate of Return to Running Is Seen After Both Arthroscopic and Open Shoulder Surgery. Arthrosc Sports Med Rehabil 2023; 5:100770. [PMID: 37560142 PMCID: PMC10407141 DOI: 10.1016/j.asmr.2023.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/03/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To determine the percentage of patients who report the ability to run 1 mile at various time points after arthroscopic and open shoulder surgery. METHODS We performed a retrospective review of prospectively collected data for all active-duty military patients aged 18 to 45 years who underwent shoulder surgery at a single institution over a 2-year period. The rehabilitation protocol discouraged running before 3 months, but all patients were able to return to unrestricted running at 3 months postoperatively. Patients were excluded if they lacked 1-year follow-up data. Parameters collected included demographic information and validated patient-reported outcome measures at the preoperative and short-term postoperative visits, as well as patients' ability to run at least 1 mile postoperatively. RESULTS A total of 126 patients were identified who underwent shoulder surgery with return-to-running data. Compared with baseline, significant improvements in patient-reported outcomes were shown at 1 and 2 years postoperatively (P = .001). The percentage of patients reporting the ability to run 1 mile postoperatively was 59% at 3 months, 74% at 4.5 months, 79% at 6 months, 83% at 12 months, and 91% at 24 months. There was no significant difference in patients undergoing shoulder surgery for instability versus non-instability diagnoses or in patients undergoing open versus arthroscopic anterior stabilization. All 11 patients unable to return to running at final follow-up had chronic lower-extremity diagnoses limiting their running ability. CONCLUSIONS Young military athletes undergoing arthroscopic and open shoulder surgery have a high rate of early return to running. Approximately 60% of patients report the ability to run 1 mile at 3 months postoperatively, and three-quarters of patients do so at 4.5 months. Age, sex, military occupation, underlying diagnosis or type of surgery did not influence the rate of return to running after shoulder surgery. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Joseph W. Galvin
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A
| | - John M. Slevin
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A
| | - Matthew J. Nowak
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A
| | - Henry H. Yu
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A
| | - Eric K. Turner
- Orthopedic Associates of Muskegon, Muskegon, Michigan, U.S.A
| | - Brian R. Waterman
- Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
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Galvin JW, Rooney P, Slevin J, Yu HH, Tokish JM, Grassbaugh JA, Arrington ED. The influence of posterior acromial morphology on outcomes and return to pushups in young patients undergoing arthroscopic posterior capsulolabral repair. JSES Int 2023; 7:737-742. [PMID: 37719809 PMCID: PMC10499847 DOI: 10.1016/j.jseint.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Prior evidence has identified specific posterior acromial morphology as significantly associated with unidirectional posterior shoulder instability. The purpose of this study is to determine the influence of posterior acromial morphology on the outcomes of arthroscopic posterior capsulolabral repair (APCLR) for unidirectional posterior shoulder instability. Additionally, we sought to determine the influence of posterior acromial morphology on the rate and time to return to pushups following APCLR. Methods We performed a retrospective review of prospectively collected data. The study included consecutive patients undergoing APCLR. Data collected included demographics, radiographic measurements including posterior acromial height (PAH) and posterior acromial tilt on preoperative scapular-Y radiographs, and patient-reported outcome measures at the preoperative and postoperative visits. In addition, starting at 6 months postoperative, patients were asked if they could perform pushups defined as at least 10 repetitions. At the final follow-up, we collected the number of pushups patients were able to perform. Results Thirty-two consecutive patients underwent APCLR with a mean follow-up of 26 months (range, 12-41). Significant improvement from preoperative to 2 years postoperative was demonstrated in Subjective Shoulder Value (50-85), VAS (6-2.5), American Shoulder and Elbow Surgeons (48 to 83), and Western Ontario Shoulder Instability (WOSI) (1437-777), P = .001. The recurrent instability rate was 3/32 (9%). Patients with PAH > 23 (N = 17) had a recurrent instability rate of 18% (3/17) versus PAH ≤ 23 (N = 15) 0% (0/15), worse WOSI scores (P = .41), and a lower number of pushups (P = .48). The percentage of patients reporting the ability to perform pushups was (6 months/1 year/2 years) (50%/78%/95%). The mean number of pushups reported at the final follow-up was 33 (range, 1-60). Discussion Following APCLR, approximately 50% of patients resume pushups at 6 months postoperatively, and 80% return at 1 year. Patients reported performing a mean of 33 pushups following APCLR at the final follow-up. Patients with a PAH greater than 23 on preoperative scapular-Y radiographs had a higher rate of recurrent posterior instability, worse WOSI scores, and lower return to pushups; however, the results did not meet statistical significance. Therefore, future larger studies are needed to determine if posterior acromial morphology is independently associated with worse outcomes and increased recurrent instability rates following APCLR.
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Affiliation(s)
- Joseph W. Galvin
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Patrick Rooney
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - John Slevin
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Henry H. Yu
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - John M. Tokish
- Department of Orthopaedic Surgery, Mayo Clinic-Arizona, Scottsdale, AZ, USA
| | - Jason A. Grassbaugh
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Edward D. Arrington
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Reiter CR, Nelson CT, Satalich JR, O'Neill CN, Cyrus JW, O'Connell RS, Vap AR. Return to sport and active military duty after cervical disc arthroplasty: A systematic review. J Orthop 2023; 39:75-82. [PMID: 37113977 PMCID: PMC10126923 DOI: 10.1016/j.jor.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Cervical disc arthroplasty (CDA) has been established as an effective treatment for cervical disc degeneration or herniation in the general population. Return to sport (RTS) outcomes in athletes remain unclear. Objective The purpose of this review was to evaluate RTS following single-level, multi-level, or hybrid CDA, with additional return to activity context provided by return to duty (RTD) outcomes in active-duty military. Methods Medline, Embase, and Cochrane were searched through August 2022 for studies that reported RTS/RTD after CDA in athletic or active-duty populations. Data was extracted on the following topics: surgical failures/reoperations, surgical complications, RTS/RTD, and postoperative time to RTS/RTD. Results Thirteen papers covering 56 athletes and 323 active-duty members were included. Athletes were 59% male with a mean age of 39.8 years and active-duty members were 84% male with a mean age of 40.9 years. Only 1 of 151 cases required reoperation and only 6 instances of surgical complications were reported. Classified as return to general sporting activity, RTS was observed in 100% of patients (n = 51/51) after an average of 10.1 weeks to training and 30.5 weeks to competition. RTD was observed in 88% of patients (n = 268/304) after an average of 11.1 weeks. Average follow-up was 53.1 months for athletes and 13.4 months for the active-duty population. Conclusion CDA displays excellent RTS and RTD rates in physically demanding populations at rates superior or equivalent to alternative treatments. Surgeons should consider these findings when determining the optimal cervical disc treatment approach in active patients.
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Affiliation(s)
- Charles R. Reiter
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Chase T. Nelson
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - James R. Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Conor N. O'Neill
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - John W. Cyrus
- Health Sciences Library, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert S. O'Connell
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Alexander R. Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
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Galvin JW, Slevin J, Yu HH, Turner EK, Tokish JM, Grassbaugh JA, Arrington ED. Rate and Time to Return to Shooting Following Arthroscopic and Open Shoulder Surgery. JSES Int 2022; 6:963-969. [DOI: 10.1016/j.jseint.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Barlow BT, Smith J. Editorial Comment: Selected Proceedings from the Society of Military Orthopaedic Surgeons 2020 Annual Meeting. Clin Orthop Relat Res 2021; 479:2373-2374. [PMID: 34586083 PMCID: PMC8509917 DOI: 10.1097/corr.0000000000001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Brian T. Barlow
- Research Director, Orthopaedic Surgery Residency Program, Naval Medical Center San Diego, San Diego, CA, USA
| | - Jennifer Smith
- Assistant Program Director, Orthopaedic Surgery Residency Program, Naval Medical Center San Diego, San Diego, CA, USA
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