Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement

Osteoarthritis Action Alliance, Secondary Prevention Task Group; Jeffrey B Driban; Heather K Vincent; Thomas H Trojian; Kirsten R Ambrose; Shelby Baez; Nicholas Beresic; David J Berkoff; Leigh F Callahan; Bruce Cohen; Madison Franek; Yvonne M Golightly; Matthew Harkey; Christopher M Kuenze; Mary Catherine Minnig; Ali Mobasheri; Adam Naylor; Connie B Newman; Darin A Padua; Brian Pietrosimone; Daniel Pinto; Hayley Root; Matthew Salzler; Laura Schmitt; Lynn Snyder-Mackler; Jeffrey B Taylor; Louise M Thoma; Kevin R Vincent; Elizabeth Wellsandt; Monette Williams

doi:10.4085/1062-6050-0504.22

Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement

J Athl Train. 2023 Mar 1;58(3):198-219. doi: 10.4085/1062-6050-0504.22.

Authors

Osteoarthritis Action Alliance, Secondary Prevention Task Group; Jeffrey B Driban¹, Heather K Vincent², Thomas H Trojian², Kirsten R Ambrose³, Shelby Baez⁴, Nicholas Beresic³, David J Berkoff⁵, Leigh F Callahan⁴, Bruce Cohen⁶, Madison Franek⁷, Yvonne M Golightly⁸, Matthew Harkey⁵, Christopher M Kuenze⁵, Mary Catherine Minnig⁸, Ali Mobasheri⁹, Adam Naylor¹⁰, Connie B Newman¹¹, Darin A Padua¹², Brian Pietrosimone¹³, Daniel Pinto¹⁴, Hayley Root¹⁴, Matthew Salzler¹⁵, Laura Schmitt¹⁶, Lynn Snyder-Mackler¹⁷, Jeffrey B Taylor¹³, Louise M Thoma¹⁸, Kevin R Vincent², Elizabeth Wellsandt¹⁹, Monette Williams¹⁹

Affiliations

¹ Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA.
² UF Health Sports Performance Center, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville.
³ Drexel University College of Medicine, Philadelphia, PA.
⁴ Osteoarthritis Action Alliance, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill.
⁵ Department of Kinesiology, Michigan State University, East Lansing.
⁶ Excusercise, LLC, Waltham, MA.
⁷ University of North Carolina Therapy Services, UNC Wellness Center at Meadowmont, Chapel Hill.
⁸ Department of Epidemiology, Thurston Arthritis Research Center, Injury Prevention Research Center, Osteoarthritis Action Alliance, University of North Carolina at Chapel Hill.
⁹ Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium.
¹⁰ Telos SPC, Boston, MA.
¹¹ Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, NYU Grossman School of Medicine, New York, NY.
¹² Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
¹³ Department of Physical Therapy, Congdon School of Health Sciences, High Point University, NC.
¹⁴ Department of Physical Therapy, Marquette University, Milwaukee, WI.
¹⁵ Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff.
¹⁶ Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus.
¹⁷ Department of Physical Therapy, University of Delaware, Newark.
¹⁸ Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill.
¹⁹ Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha.

Abstract

Context: The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury.

Objective: Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps.

Design: Consensus process.

Setting: Virtual video conference calls and online voting.

Patients or other participants: The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds.

Main outcome measure(s): The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation.

Results: The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models.

Conclusions: This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.

Keywords: injury prevention; patient education; physical activity; psychological stress; rehabilitation.

Publication types

Consensus Development Conference

MeSH terms

Anterior Cruciate Ligament Injuries* / prevention & control
Consensus
Humans
Knee Injuries*
Osteoarthritis* / prevention & control
Secondary Prevention

Grants and funding

This publication was supported by the Centers for Disease Control and Prevention (CDC) of the US Department of Health and Human Services (HHS) as part of a financial assistance award (1 NU58 DP006980-01) totaling $461 914 with 65% funded by CDC/HHS and $250 000 and 35% funded by nongovernment source(s).