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

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.
Competing Interests: Competing interests: JLW, AGC, BP, EM and CE are associate editors of the British Journal of Sports Medicine (BJSM). CLA is the editor in chief and JLW an editor with the Journal of Orthopaedic and Sports Physical Therapy (JOSPT). AGC is an associate editor of Osteoarthritis and Cartilage. SF is an associate editor for Journal of Science in Medicine and Sport. JBT holds a research grant from Pfizer outside the submitted work. STS is co-founders of Good Life with Osteoarthritis from Denmark (GLA:D), associate editor of the JOSPT and has received grants from the Lundbeck Foundation and personal fees from Munksgaard and TrustMe-Ed, outside the submitted work. CMT is project leader of GLA:D, Ireland. MAR is a project leader of the Active Living with Osteoarthritis in Norway (AktivA), a not-for-profit initiative to implement clinical guidelines in primary health care in Norway. ER is a deputy editor of Osteoarthritis and Cartilage, developer of Knee injury and Osteoarthritis Outcome Score and several other freely available patient-reported outcomes, and founder of GLA:D. KMC is a senior advisor of BJSM, project leader of the GLA:D, Australia, and holds a research grant from Levin Health outside the submitted work.
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