Australia has one of the world’s highest and fastest growing rates of serious knee injuries such as anterior cruciate ligament (ACL) ruptures and meniscal tears.

Facilitating a return to work and the resumption of sporting and recreational pursuits is a common goal of knee injury rehabilitation in the short to medium term.

Unfortunately, approximately 50 per cent of people who experience a serious knee injury will develop knee osteoarthritis (OA) within 10 years.

This rapid onset of post-traumatic OA can significantly diminish physical activity and quality of life in young adults, contributing to a higher risk of impaired long-term physical and psychological health.

The body of evidence on the accelerated development of post-traumatic OA points to a unique window of opportunity following injury to delay, halt or reduce the severity of post-traumatic OA.

Despite this opportunity to optimise longer-term knee health after injury, the prevention of post- traumatic OA has yet to gain momentum.

OPTIKNEE: optimising knee health after injury

To address this challenge, a consortium of 40 international experts including scientists, clinicians and patients from Australia, Canada, Denmark, Ireland, the Netherlands, Norway, Sweden and the United States formed the OPTIKNEE team.

Pooling the available research, they developed recommendations to optimise knee health and prevent post-traumatic OA.

They conducted seven systematic reviews, mostly published in a dedicated issue of the British Journal of Sports Medicine (December 2022), with data from more than 230 studies and 133,000 patients.

These reviews led to the co-creation of clinical recommendations to guide rehabilitation, improve knee health and prevent/delay OA following a traumatic knee injury.

The recommendations (summarised in Table 1 below) serve as an initial framework, meant to spark dialogue and to be adapted as new evidence comes to light.

Thus the OPTIKNEE recommendations are only the beginning.

They can be used by physiotherapists to raise awareness of post-traumatic knee OA risks among young adult patients and to offer guidance on target groups and appropriate actions.

They also provide insights into the most appropriate intervention(s) and the best outcomes for monitoring progress over time.

These recommendations can assist clinicians, patients, researchers and other stakeholders in advocating for, developing, testing and implementing evidence-based, patient-centred rehabilitation programs aimed at reducing the burden of post-traumatic knee OA.

To help with global implementation, the recommendations have been translated into more than 15 languages and the OPTIKNEE team is currently working with patients and clinicians to understand each group’s perceived barriers and preferred solutions for adopting the recommendations.

If you know of a clinician or patient interested in being involved in this work, contact us at kneestudy@latrobe.edu.au

Monitoring knee injury outcomes—a new Australian initiative

One of the key OPTIKNEE recommendations emphasises the importance of monitoring outcomes to help understand and interpret improvement (or deterioration) in a particular domain over time.

This is important at an individual patient level to help guide progress through the different phases of a rehabilitation program and provide motivation (by setting and achieving rehabilitation milestones).

At a larger population level, monitoring outcomes can provide important insights into the broader burden of knee injuries and predictors of treatment success or failure.

Examples of such population-level initiatives include national knee injury projects, common in Scandinavia over the past few decades, with its world-leading ACL reconstruction surgical registries.

Despite calls for many years for an Australian ACL reconstruction registry, one is yet to be successfully established.

Given the rising number of Australians opting for non-surgical management of their ACL injury, it is important to include those who choose to take a non-operative rehabilitation pathway in any national outcome monitoring initiative.

Enter the Australian Knee Injury Study.

This national project, led by researchers at La Trobe University’s La Trobe Sport and Exercise Medicine Research Centre in collaboration with physiotherapists and patient partners across Australia, aims to understand best-care practices and long-term outcomes.

More specifically, it aspires to:

• understand healthcare pathways for people with a knee injury, including timing and frequency of physiotherapy consultations 
• identify healthcare system and patient-related predictors of treatment pathway (eg, surgical versus non-surgical, uptake of rehabilitation) 
• determine the prognosis of different knee injuries and treatment pathway outcomes.

The study relies on physiotherapists to refer knee-injured patients and will include as many Australians as possible who have had a traumatic knee injury in the previous six months.

These individuals will be followed up for 10 years with brief (less than five minutes) online questionnaires at six months and at one, two, five and 10 years post-injury.

This national study, 100 per cent online and recruiting from 2024 to 2028, is collecting data directly from patients to provide an understanding of the healthcare providers seen by patients after a knee injury and their referral patterns.

The study will also explore the percentage of patients who end up opting for surgical management and the factors associated with this choice, along with the short-, mid- and long-term (up to 10 years) outcomes of different surgical and non-surgical management approaches for common injuries such as ACL ruptures and meniscal tears.

To achieve this, all physiotherapists in Australia who see and treat patients with traumatic knee injuries are encouraged to visit kneeinjurystudy.com.au for more information and to assist their patients to join this fully online study.

The study needs you to help shape the future of knee health in Australia.

>>Associate Professor Adam Culvenor APAM is a principal research fellow, National Health and Medicine Research Council Emerging Leadership Fellow and head of the Knee Injury Research Group at the La Trobe Sport and Exercise Medicine Research Centre. Adam’s research focuses on the prevention, management and outcomes of knee injuries in adolescents and young adults—particularly ACL injuries and the development of post-traumatic osteoarthritis. Adam is co-lead of the international OPTIKNEE consortium and project lead for the Australian Knee Injury Study.

>>Dr Marc-Olivier Dubé is a physiotherapist and postdoctoral research fellow (Quebec Health Research Fund) at the La Trobe Sport and Exercise Medicine Research Centre. His research there focuses on the true burden of traumatic knee injuries in Australia and examines how different sociodemographic characteristics and healthcare pathways may influence long-term outcomes. Marc-Olivier is the project coordinator for the Australian Knee Injury Study.