OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis

Abstract

The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.

Clinically Relevant Subgroups Among Athletes Who Have Ruptured Their Anterior Cruciate Ligaments: A Delaware‐Oslo Cohort Study

“…Similarly, the term “clinical knee OA” was used to describe the partial application of the Luyten et al (12) criteria in our sample to be consistent with previous published work from our cohort (30). However, this term may also be described as early knee OA symptoms and is consistent with the heterogeneity in early OA definitions for this population described by the most recent OPTIKNEE consensus (54).…”

The Delaware‐Oslo ACL Cohort treatment algorithm yields superior outcomes to usual care 9–12 years after anterior cruciate ligament reconstruction

“…At the time of ACLR, the participants from the Delaware‐Oslo ACL Cohort had resolved initial acute impairments and completed a 5‐week rehabilitation programme after injury. This approach aligns with current evidence and recommendations for ACL rehabilitation, which encourage preoperative rehabilitation to optimise postoperative outcomes [27, 28]. The rehabilitation programme included progressive neuromuscular exercises, heavy resistance strength training and plyometrics [4].…”

“I feel I'm leading the charge.” Experiences of a virtual physiotherapist-guided knee health program for persons at-risk of osteoarthritis after a sport-related knee injury

“…Emerging consensus recommendations to prevent post-traumatic knee OA advocate for informational support (i.e., education) and exercise-based interventions that target potential risk factors and promote self-care through person-centered goals [ 6 ]. This guidance is consistent with previous work that identified autonomy, and timely informational and emotional support about short- and long-term knee health as important for recovery after anterior cruciate ligament (ACL) injuries [ 7 , 8 ].…”