The Effects of Different Management Strategies or Rehabilitation Approaches on Knee Joint Structural and Molecular Biomarkers Following Traumatic Knee Injury : A Systematic Review of Randomized Controlled Trials for the OPTIKNEE Consensus

Abstract

OBJECTIVE: To summarize the effectiveness of management strategies and rehabilitation approaches for knee joint structural and molecular biomarker outcomes following anterior cruciate ligament (ACL) and/or meniscal tear. DESIGN: Intervention systematic review. LITERATURE SEARCH: We searched the MEDLINE, Embase, CINAHL, CENTRAL, and SPORTDiscus databases from their inception up to November 3, 2021. STUDY SELECTION CRITERIA: We included randomized controlled trials (RCTs) investigating the effectiveness of management strategies or rehabilitation approaches for structural/molecular biomarkers of knee joint health following ACL and/or meniscal tear. DATA SYNTHESIS: We included 5 RCTs (9 papers) with primary ACL tear (n = 365). Two RCTs compared initial management strategies (rehabilitation plus early vs optional delayed ACL surgery), reporting on structural biomarkers (radiographic osteoarthritis, cartilage thickness, meniscal damage) in 5 papers and molecular biomarkers (inflammation, cartilage turnover) in 1 paper. Three RCTs compared different post-ACL reconstruction (ACLR) rehabilitation approaches (high vs low intensity plyometric exercises, accelerated vs nonaccelerated rehabilitation, continuous passive vs active motion), reporting on structural biomarkers (joint space narrowing) in 1 paper and molecular biomarkers (inflammation, cartilage turnover) in 2 papers. RESULTS: There were no differences in structural or molecular biomarkers between post-ACLR rehabilitation approaches. One RCT comparing initial management strategies demonstrated that rehabilitation plus early ACLR was associated with greater patellofemoral cartilage thinning, elevated inflammatory cytokine response, and reduced incidence of medial meniscal damage over 5 years compared to rehabilitation with no/delayed ACLR. CONCLUSION: Very low-certainty evidence suggests that different initial management strategies (rehabilitation plus early vs optional delayed ACL surgery) but not postoperative rehabilitation approaches may influence the incidence of meniscal damage, patellofemoral cartilage loss and cytokine concentrations over 5 years post-ACL tear.

• author: Holm, Patur M. ; Juhl, Carsten B. ; Culvenor, Adam G. ; Whittaker, Jackie L. ; Crossley, Kay M. ; Roos, Ewa M. ; Patterson, Brooke E. ; Larsson, Staffan ; Struglics, André and Bricca, Alessio
• organization: Orthopaedics (Lund); Lund OsteoArthritis Division - Molecular marker research group (research group)
• publishing date: 2023-05
• type: Contribution to journal
• publication status: published
• subject: Orthopedics
• keywords: anterior cruciate ligament, biomarkers, molecular, rehabilitation, structural
• in: Journal of Orthopaedic and Sports Physical Therapy
• volume: 53
• issue: 4
• pages: 22 pages
• publisher: J O S P T, Alliance Group Communications
• external identifiers: pmid:36802814; scopus:85150666653
• ISSN: 0190-6011
• DOI: 10.2519/jospt.2023.11576
• language: English
• LU publication?: yes
• additional info: Funding Information: 1Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark. 2Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 3Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospitals, Copenhagen, Denmark. 4La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia. 5Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada. 6Arthritis Research Canada, Vancouver, British Columbia, Canada. 7Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia. 8Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. ORCID: Holm, 0000-0001-5205-2644; Juhl, 0000-0001-8456-5364; Culvenor, 0000-0001-9491-0264; Whittaker: 0000-0002-6591-4976; Crossley, 0000-0001-5892-129X; Roos, 0000-0001-5425-2199; Patterson, 0000-0002-6570-5429; Larsson, 0000-0001-8626-9892; Struglics, 0000-0003-4289-1393; Bricca, 0000-0001-9717-918X. The protocol was prospectively registered on the Open Science Framework website (https://osf.io/4sak7/). This review is part of the OPTIKNEE consensus (https://bit.ly/OPTIKNEE), which has received funding from the Canadian Institutes of Health Research (OPTIKNEE principal investigator: J.L.W.; number 161821). The funders had no role in any part of the study or in any decision about publication. A.G.C., B.E.P., and J.L.W. are Associate Editors of the British Journal of Sports Medicine (BJSM). J.L.W. is an Editor with the Journal of Orthopaedic & Sports Physical Therapy. K.M.C. is a senior advisor of BJSM, project leader of the Good Life with osteoArthritis in Denmark (GLA:D®) – Australia, a not-for-profit initiative to implement clinical guidelines in primary care, and holds a research grant from Levin Health outside the submitted work. C.B.J. is an Associate Editor of Osteoarthritis and Cartilage. E.R. is the Deputy Editor of Osteoarthritis and Cartilage, a developer of Knee injury and Osteoarthritis Outcome Score (KOOS) and several other freely available patient-reported outcome measures, and the founder of the GLA:D®. The authors affirm that they have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript. Address correspondence to Pætur M. Holm, Fælledvej 2C, 4200 Slagelse, Denmark. E-mail: [e-mail] t Copyright ©2023 JOSPT ®, Inc Funding Information: ACKNOWLEDGMENTS: P.M.H. is supported by Publisher Copyright: © 2023 JOSPT.
• id: f623d0c5-9f45-4a4c-8f77-1f6f954e90aa
• date added to LUP: 2024-01-12 13:42:06
• date last changed: 2024-04-13 07:09:38