Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus

Culvenor, Adam G; Girdwood, Michael; Juhl, Carsten Bogh; Patterson, Brooke E; Haberfield, M.; Holm, Pætur Mikal; Whittaker, Jackie L.; Roos, Ewa M.; Crossley, Kay M

doi:10.1136/bjsports-2022-105495

Cited by 29 publications

(21 citation statements)

References 57 publications

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“…One patient partner and one clinician (sports and exercise medicine physician) were authors on the risk factor review, 29 and one additional patient and clinician partner provided feedback on one of the intervention reviews. 30 A patient partner and a clinician (physiotherapist) provided feedback on this manuscript.…”

Section: Patient and Public Involvementmentioning

confidence: 99%

“…RoB: NIHQAT 34 Certainty: GRADE 50 Risk factors for knee OA after traumatic knee injury 29 Primary: identify and quantify the magnitude of potential modifiable and non-modifiable risk factors for symptomatic and structural knee OA following a traumatic knee injury Meta-analyses and semi-quantitative RoB: QUIPS 51 Certainty: GRADE approach for prognostic factor reviews 52 Rehabilitation after traumatic ACL and meniscal tear: clinical outcomes 30 Primary: critically appraise and synthesise systematic review evidence of RCTs assessing rehabilitation interventions following ACL and/or meniscal tear to improve symptomatic, functional, clinical, psychosocial or quality of life outcomes and prevent re-injury Narrative RoB: ROBIS tool 53 Certainty: GRADE 54 Rehabilitation after traumatic ACL and meniscal tear: structural and molecular biomarkers 35 Primary: synthesise existing RCT evidence of different management strategies and rehabilitation approaches to ACL and/or meniscal tear on structural and molecular biomarkers of knee joint health Narrative RoB: Cochrane ROB 2.0 tool 1 Certainty: GRADE 43 Meaningful thresholds for patient reported outcomes for traumatic ACL or meniscal tear 36 Primary: identify, critically appraise and synthesise estimates for thresholds defining meaningful PROs scores for use with individuals treated for a traumatic ACL tear and/or meniscal injury…”

Section: Meta-analyses Narrativementioning

confidence: 99%

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

et al. 2022

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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.

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Section: Patient and Public Involvementmentioning

confidence: 99%

Section: Meta-analyses Narrativementioning

confidence: 99%

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

et al. 2022

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“…Structural knee OA was defined differently across included studies (eg, joint space narrowing, Kellgren and Lawrence classification and adding symptoms to definition) and there was no observable trend for the impact of hop test performance and structural OA based on length of follow-up. In the context of OA prevention, addressing impairments in hop tests (ie, quadriceps weakness) may provide a target for intervention though RCTs are required to confirm this 48 49…”

Section: Discussionmentioning

confidence: 99%

Unilateral tests of lower-limb function as prognostic indicators of future knee-related outcomes following anterior cruciate ligament injury: a systematic review and meta-analysis of 13 150 adolescents and adults

et al. 2023

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ObjectiveTo investigate the prognostic capacity of individual hop tests, hop test batteries and other unilateral functional performance tests following anterior cruciate ligament (ACL) injury.DesignSystematic review with meta-analysis.Data sourcesSix databases searched up to June 2021.Eligibility criteriaStudies reporting associations between unilateral lower-limb function (eg, hop tests) following ACL injury and future (≥3 months) knee-related outcomes.ResultsOf 42 included studies (13 150 participants), all assessed the single-forward hop test and 32 assessed a repeated-forward hop test (crossover hop, triple hop, 6m-timed hop), mostly within a year after ACL injury/reconstruction. Results of meta-analyses indicated that higher single-forward and repeated-forward hop limb symmetry were associated with higher odds of return-to-sport 1–3 years post-ACL reconstruction (OR 2.15; 95% CI 1.30 to 3.54; OR 2.11; 95% CI 1.23 to 3.60, respectively). Higher single-forward and repeated-forward hop limb symmetry was associated with better self-reported symptoms and function 1–37 years after ACL injury (OR 2.51; 95% CI 1.62 to 3.88; OR 4.28; 95% CI 1.65 to 11.08, respectively). Higher limb symmetry on a repeated-forward hop does not appear to be associated with higher odds of successful rehabilitation without ACL reconstruction (OR 1.51; 95% CI 0.94 to 2.44). Achieving ≥90% limb symmetry on the single-forward hop was associated with reduced odds of knee osteoarthritis 5–37 years after ACL injury (OR 0.46; 95% CI 0.23 to 0.94).ConclusionVery low certainty evidence suggests single-forward and repeated-forward hop tests are prognostic indicators for important knee-related outcomes in individuals after ACL injury and may help stratify individuals at risk of poor outcomes to target rehabilitation interventions.PROSPERO registration numberCRD42018092197.

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“…14 Also, recent published work provided an overview of systematic reviews on the effectiveness of rehabilitation interventions after ACLR. 19 However, previous clinical practice guidelines 14 and the recent systematic review 19 fail to provide clinically relevant information required for daily practice, including advice for exercise initiation, eccentric training, plyometrics training, cross-education. The following guideline document translates the available evidence into clinical recommendations based on expert consensus to informing the treating clinician.…”

Section: Introductionmentioning

confidence: 99%

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

et al. 2023

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This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose–response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.

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Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus

Cited by 29 publications

References 57 publications

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

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

Unilateral tests of lower-limb function as prognostic indicators of future knee-related outcomes following anterior cruciate ligament injury: a systematic review and meta-analysis of 13 150 adolescents and adults

Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

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