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BackgroundAcceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. ObjectiveThis study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. MethodsAdult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. ResultsA total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04). ConclusionsIn this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. Trial RegistrationClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546

BackgroundIn March 2020, elective total hip and knee arthroplasty (THA and TKA) were suspended across the United States in response to the COVID-19 pandemic. We had previously published the results of a survey to the affected patients from 6 institutions. We now present the results of a larger distribution of this survey, through May and June 2020, to electively scheduled patients representing different regions of the United States.MethodsFifteen centers identified through the American Association of Hip and Knee Surgeons Research Committee participated in a survey study of THA and TKA patients. Patients scheduled for primary elective THA or TKA but canceled due to the COVID-19 elective surgery stoppage (3/2020-5/2020) were included in the study. Descriptive statistics along with subgroup analysis with Wilcoxon rank were performed.ResultsIn total, surveys were distributed to 2135 patients and completed by 848 patients (40%) from 15 institutions. Most patients (728/848, 86%) had their surgery postponed or canceled by the surgeon or hospital. Unknown length of surgical delay remained the highest source of anxiety among survey participants. Male patients were more likely to be willing to proceed with surgery in spite of COVID-19. There were minimal regional differences in responses. Only 61 patients (7%) stated they will continue to delay surgery for fear of contracting COVID-19 while in the hospital.ConclusionSimilar to the previous study, the most anxiety-provoking thought was the uncertainty, over if and when the canceled joint replacement surgery could be rescheduled. Patients suffering from the daily pain of hip and knee arthritis who have been scheduled for elective arthroplasty remain eager to have their operation as soon as elective surgery is allowed to resume.

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: The tibiofibular syndesmosis is a fibrous joint essential for ankle stability. Injury to the syndesmotic ligaments in high-ankle sprains are destabilizing and cause considerable time lost to injury and long-term disability. Stability imparted by the lateral ankle ligaments in the setting of a high ankle sprain and their interplay has not previously been elucidated in the literature. Sequelae of ligamentous injuries include multidirectional instability and posttraumatic arthritis, likely from altered joint mechanics, impingement, and changes in ligamentous strain. This study aimed to determine the role of individual lateral and syndesmotic ankle ligaments on ankle tissue mechanics and joint stability. We hypothesized that ligament strain and relative bony ankle motion would increase with sequential ligamentous injury. Methods: 22 through-knee lower extremity specimens underwent mechanical testing with an axially loaded external rotation (ER) stress. Specimens were randomized into either a high sprain (sequence 1, n=11, AITFL, IOL, PITFL, ATFL, CFL) or low sprain (n=11, ATFL, CFL, AITFL, IOL, PITFL) ligament transection sequence. Specimens were mounted on an MTS load frame (MTS Inc. Eden Prairie, MN), axially loaded to 750 N, and 5Nm of ER torque stress was applied. Degrees to target ER torque were compared between sequences using linear regression modeling. AITFL and ATFL strain was measured throughout load application using an optical digital image correlation system (ARAMIS, GOM, Braunschweig, Germany). Mean strain was measured for loading tests after each sequential ligament transection. Signed rank tests were utilized to compare the mean strain in the AITFL or ATFL referencing the intact specimen. Results: Upon application of 5 Nm of torque in intact specimens, mean ATFL strain was consistently higher vs AITFL strain. In the high sprain group, ATFL strain gradually decreased after each syndesmotic ligament transection. No statistical differences were identified in this trend vs intact specimens (p=0.69,p=0.44, p=0.69, for AITFL, IOL, PITFL transection). Torsional angle increased with each ligament transection within the high sprain group. In contrast, AITFL strain and torsional angle remained constant after each lateral ligament transection in low ankle sprains. No significant difference in strain on the AITFL in the (p=0.69 and p=0.94) for ATFL and CFL transection, respectively. For both groups, there was no statistically significant difference in rotation angle resulting from 5 Nm of applied ER force after any individual ligament transection. Conclusion: This study used a novel strain tracking approach to quantify the ligament strain in high and low ankle sprains. Contrary to the initial hypothesis, it was found that ATFL strain decreased, and ankle rotation increased with increasing severity of high sprain. AITFL strain and ankle rotation angles remained consistent through increasing severity of low sprains. While the differences in rotation and strain were not statistically significant, greater ankle rotation could amplify the trends identified in ligament strain behavior. It is expected the reduction in strain results from bony impingement under greater rotation in the ligament deficient ankles. [ABSTRACT FROM AUTHOR]