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Step One to Preventing Chronic Knee Pain? Talk About It!


Limiting the risk of osteoarthritis after anterior cruciate ligament injury: Are health care providers missing the opportunity to intervene?

Davis AM, Chahal J, Wong R, Steinhart K, Dwyer T, Li L, Marks P, Cruz L, Urquhart N, Wilson JA, Cudmore D, Nimmon L, Ogilvie-Harris D. Arthritis Care Res. 2020 Sept 16. doi: 10.1002/acr.24419.

https://pubmed.ncbi.nlm.nih.gov/32937005/

Take-Home Message

Health care professionals, especially physical therapists, do not consistently discuss osteoarthritis risk with patients after anterior cruciate ligament (ACL) injury.

Summary

Someone with an ACL injury has up to a 50% chance of developing osteoarthritis – a leading cause of disability – within 15 years after their injury. Unfortunately, less than 30% of people with an ACL reconstruction remember discussing their risk for osteoarthritis with a health care professional, which explains why only 5% of patients think they are at risk for osteoarthritis. Thus, the researchers surveyed Canadian orthopedic surgeons, physical therapists, and primary care physicians with sports training to determine 1) if they provide information on osteoarthritis risk factors and management strategy, 2) what information they provide, 3) when they offer this information, and 4) who they believe should provide this information to non-elite athletes with an ACL injury. The health care professionals received the survey through email, mail, or fax from April to December 2017. Surveys took about 10 minutes to complete and asked about 1) their demographics, 2) frequency and factors influencing discussion of osteoarthritis risk, 3) timing of this discussion, 4) advice and resources provided regarding osteoarthritis risk, and 5) opinion of which health care professionals should talk about osteoarthritis risk factors with patients.

The authors received responses from 140 orthopedic surgeons, 263 physical therapists, and 98 primary care physicians, with most reporting 5+ years experience. Over 70% of physicians reported always discussing osteoarthritis risk, while only 34% of physical therapists reported the same. Health care professionals reported injury to another knee structure (71-88%) and a subsequent ACL tear (83-81%) as the most common factors resulting in discussions about osteoarthritis risk. Meanwhile, sex and age were the least common factors. Physicians discussed osteoarthritis risk more frequently during the initial ACL injury assessment (>80%) than after the initial assessment (42% orthopedic and 13% primary care, respectively). About 75% of providers offered advice for managing osteoarthritis risk, with strength training, weight management, and activity modification being the most common recommendations. Finally, over 80% of providers believed that physical therapists are an appropriate resource for osteoarthritis risk information.

Viewpoints

The authors found that physicians often discuss risk and management of osteoarthritis with patients after an ACL injury. However, this discussion primarily occurs at the initial visit when patients may be focused on more immediate concerns. This may explain why only 5% of patients remember having discussions about osteoarthritis after an ACL injury. Patients with an ACL injury can benefit from more frequent discussions with health care professionals regarding osteoarthritis risk factors and management. Another team of researchers found that 70 to 80% of athletic trainers discuss risk and strategies to mitigate the risk of osteoarthritis after an ACL or meniscal injury; however, it is unclear when they provide this information. Specifically, clinicians delivering rehabilitation should be prepared to discuss modifiable risk factor management throughout the rehabilitation timeline. Resources like the OACareTools educational toolkit, supported by the NATA and APTA, may provide helpful information and patient handouts for clinicians to help empower patients.  

Questions for Discussion

What is the best way to increase the frequency of discussions about osteoarthritis between health care professionals and patients with ACL injuries? Why do some health care professionals discuss modifiable osteoarthritis risk factors with patients while other health care professionals do not?

Written by: Ryan Paul
Reviewed by: Jeffrey Driban

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