Background/Purpose: Fifty percent of people with anterior cruciate (ACL) injury develop knee osteoarthritis (OA) within 6-10 years, even with ligament reconstruction. Despite evidence that targeted exercise, appropriate physical activity and weight management effectively limit symptomatic knee OA, only 27% (62/233) of Australians and Americans with ACL reconstruction 1-5 years previously, remembered discussing OA risk with any health care professional (HCP). We conducted a survey to understand what Canadian sports orthopedic surgeons, primary care physicians (PCPs) and physiotherapists (PTs) managing non-elite athletes with ACL injury do or do not tell their patients about their OA risk.

Methods:

We surveyed practicing sports orthopedic surgeons, PCPs and PTs who provide care to non-elite athletes with acute ACL injury.

The electronic survey was distributed through an e-blast and newsletter link by the Canadian Academy of Sport and Exercise Medicine (CASEM) (many members are PCPs with specialty training in sports) and the Sports and Orthopedic Divisions of the Canadian Physiotherapy Association. Orthopedic surgeons were contacted via telephone and or email and completed the survey via fax, mail or online. The survey included four sections: practitioner demographics; frequency and specific factors discussed; when post-injury risk factors are discussed; and, recommendations for how and with whom risk factors and their management should be discussed.

Results: There were 98 PCP, 263 PT, and 140 orthopedic surgeon respondents. All Canadian provinces and 2 of 3 territories were represented. Seventy-five or more of each provider group had greater than 5 years’ experience treating people with ACL injury. Seventy to 77% of physicians reported that they always discussed OA risk but only 35% of PTs do (Table 1). All groups reported that patient activity level (i.e. activities perceived as detrimental to knee health), ACL re-injury and simultaneous injury to other structures in the knee were most often the reason for discussing OA risk. A high proportion of providers discussed OA risk as part of initial management with many fewer respondents reporting such discussions 3-6 months after injury. Despite a lower proportion of PTs reporting always discussing OA risk, 80% of the physicians and 99% of the PTs indicated that PTs were best suited to provide OA risk information.

Conclusion: These results suggest that there is a communication gap as HCPs, particularly PTs, who routinely manage people with ACL injury do not consistently discuss OA risk post injury. Discussions occur only early post injury when the focus is likely on ACL recovery. Subsequently, there is a lack of emphasis on managing OA risk at final follow-up, when it’s likely most important. Educational strategies for health professionals are needed to develop care pathways inclusive of support for OA risk management post ACL injury.

Table 1:

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/limiting-the-risk-of-osteoarthritis-after-anterior-cruciate-ligament-injury-are-we-missing-the-opportunity-to-intervene/