Bmj Military Health最新文献

Introduction: Anterior cruciate ligament reconstruction (ACL reconstruction) and the subsequent return to military duty are important concerns for military personnel. This study aimed to evaluate the outcomes of ACL reconstruction and the rate of and factors influencing return to duty among military personnel.

Methods: A retrospective cross-sectional study of military personnel undergoing ACL reconstruction between 2010 and 2020, with at least 2 years of follow-up. Demographic data, injury and surgery details, activity at injury, Lachman test, Lysholm score, complications and return to military duty were recorded.

Results: We included 408 military personnel. Injuries mostly occurred during sports (76.5%), mainly football. Autologous hamstring tendon grafts were used in 79.2%. Meniscal injury was present in 54.9%, treated with repair or partial meniscectomy. Complications were infrequent, with 0.7% infection or graft re-rupture. Postoperative knee stability improved significantly, with 84.1% showing no anterior tibial translation. Over 90% achieved good or excellent Lysholm scores. Return to duty was achieved in 89.2%, with the majority returning to previous military duties; 8.8% had occupational reassignment due to physical limitations, and 2% were medically discharged. Most patients had a normal body mass index (BMI); return rates were lower in patients with BMI <18.5 or ≥30.

Conclusions: ACL reconstruction provides favourable functional and stability outcomes, resulting in high return-to-duty rates in military personnel. Extremes of BMI adversely impact return to duty, highlighting the need for tailored perioperative and rehabilitation strategies to optimise recovery and military readiness.

Obesity remains a significant public health concern with substantial implications for military readiness. Rising rates of overweight and obesity among service members challenge recruitment, retention and deployability. Although the military continues to screen and manage obesity, current body composition tools and policies often fail to capture true health risk or operational capability. This narrative review evaluates the prevalence and impact of obesity in the US military, critiques existing assessment methods and discusses recent policy updates across service branches. Particular attention is given to limitations of traditional metrics such as body mass index and circumference-based measures, as well as the potential of modern approaches to improve accuracy and effectiveness. Despite policy revisions, obesity remains the leading medical disqualifier for service and a major contributor to lost workdays, injuries and medical costs. Aligning body composition standards with scientific evidence and operational demands is essential for supporting readiness across modern defence forces.

Modern military and operational missions demand sustained performance under extreme physiological, cognitive and environmental stress. Soldiers, aviators and naval personnel experience dynamic interactions between fatigue, heat, dehydration, psychological load and injury risk, that is, conditions that evolve rapidly and are influenced by both individual and environmental factors. Despite the widespread use of wearables, physiological monitors and cognitive assessments, data remain fragmented and largely reactive. Digital twin technology is an adaptive computational model that mirrors and predicts the state of a real individual in real time and offers a transformative framework for proactive human performance and health management. Here, we outline the conceptual foundation, data architecture and operational roadmap for developing digital twins tailored to military personnel. By integrating multimodal physiological, cognitive and environmental data, digital twins could forecast performance degradation, stress injury or medical emergencies before they occur, enabling personalised countermeasures and mission-level decision support. Such systems would move defence health from observation to prediction, enhancing resilience, readiness and safety in complex operational theatres.

Introduction: Intraosseous devices have become an alternative to peripheral intravenous (PIV) access. Despite the established success of intraosseous devices in laboratory and simulator studies, there is a lack of data regarding their real-world utilisation in prehospital settings. Therefore, this study aims to evaluate the success rates of intraosseous access in a prehospital military context and identify factors associated with failure.

Methods: Using the Israel Defense Forces (IDF) Trauma Registry, we retrospectively collected data from 2010 to 2023. The primary outcome was the first pass success rate of intraosseous access, and logistic regression models were applied to identify variables associated with first pass failure.

Results: The study included 172 trauma patients who underwent attempted intraosseous access with 46.5% cases which were classified as military events. The median age was 22 years, and 17.3% were paediatric patients. First pass success was achieved in 67.4% of cases, with a cumulative success rate of 80.8% after multiple attempts. Moreover, significant differences were noted when examining the success rate of the three intraosseous devices used by the IDF teams, with the highest success rate being documented for the NIO Adult versus the EZ-IO or the BIG (81.4%; 76.7%; 62.4%). However, logistic regression analysis revealed that the number of PIV access attempts was the only variable significantly associated with decreased odds of achieving first pass intraosseous access.

Conclusion: These findings suggest that intraosseous devices are a viable alternative for establishing vascular access in prehospital military settings. However, success rates were slightly lower than previous reports, potentially due to the severity of injuries in the study cohort. Our analyses revealed a higher number of PIV access attempts correlated with reduced first pass intraosseous success, possibly stemming from caregiver proficiency in obtaining vascular access. Further research is needed to explore additional factors affecting intraosseous access success rates.

Introduction: Achilles tendon rupture (ATR) is a serious musculoskeletal injury that results in substantial functional decline, especially in highly physically demanding occupations such as service in the military. The purpose of this retrospective cohort study was to evaluate the prevalence and associated factors of ATR in US military service members.

Methods: The Defence Medical Epidemiology Database was used to identify all diagnosed ATR in military personnel from 2006 to 2015. The prevalence of ATR was calculated and compared by year, service branch and military rank. Unadjusted and adjusted assessments of risk were calculated.

Results: Officers incurred 15 978 episodes at a prevalence of 7.43/1000 (male: 8.11/1000; female: 3.89/1000). Among enlisted personnel, there were 59 242 episodes of ATR that occurred at a prevalence of 6.23 episodes per 1000 (male enlisted: 6.49/1000; female enlisted: 4.48/1000). Apart from enlisted aviation specialists (where there was no significant difference in risk between men and women), both female officers and enlisted service members had significantly lower risk of ATR compared with their male counterparts in all occupations (prevalence ratio (PR): 0.26-0.73). Aviation and service officers demonstrated significantly lower risk of ATR episodes (PR: 0.87-0.91) and administration, operations, intelligence and logistic officers demonstrated increased risk (PR: 1.16-1.31) compared with ground and naval gunfire officers. Among enlisted specialties, all but mechanised/armour and combat engineers had significantly higher risk of ATR risk compared with infantry (PR: 1.14-2.13), with the highest risk observed in the administration, intelligence and communication fields.

Conclusions: ATR was ubiquitous in the US military, with multiple risk factors identified, including male sex, older age, rank, military occupation and service branch. These findings highlight the populations that can most greatly benefit from preventive screening and care.

Introduction: In this study, we used surface electromyography (EMG) electrodes in order to measure and compare activity in the neck, back and thigh muscles of soldiers wearing two different types of body armour. A secondary objective was to analyse shoulder and hip ranges of motion using inertial motion sensors.

Methods: Fourteen male soldiers were instructed to march 6 km on a treadmill while wearing different types of body armour. All participants wore shorts and a T-shirt and the same size vest regardless of their body size. We measured back and thigh muscle activity as well as shoulder and hip ranges of motion at regular intervals during the march.

Results: Over the course of a 6 km march, muscle activity was already increased to 1.3 to 2.0 times after putting on the vest and increased by up to 13 times during the march with equipment. The new vest with hip belt required higher levels of muscle activity.

Conclusions: Body armour with hip belt placed higher levels of stress on back and neck muscles during a 6 km march than without. There was no major difference between the two types of body armour in terms of thigh muscle activity.

Trial registration number: DRKS00016005.