e-knee. Exercise for Knee injuries



Knee joint injuries are common(1), account for up to 40% of time-loss injuries in sport (i.e., requiring absence from sport for any period of time), and constitute a substantial part of the caseload in acute/subacute health care settings(2,3). Traumatic single- and multistructure knee joint injuries (cruciate ligament, collateral ligament, meniscus, chondral, fracture, dislocation) are not self-limiting in that they are associated with significant short- and long-term consequences(4–7) and societal burden(6). Up to 90% of adolescents and young adults who sustain an ACL and/or meniscal tear, develop radiographic signs of knee osteoarthritis (OA) within 10-20 years regardless of treatment approach(4), representing a 4- to 6-fold higher risk compared to non-injured peers(8). Significant time-loss knee injuries (e.g., ACL and meniscal tears) also carry a substantial psychological impact on the individual(9,10). Most prominent is the fear and anxiety related to return to daily activities, sport or physical activity(11,12). These psychological factors are highly correlated with a successful outcome of treatment and return to pre-injury levels of physical activity or sports(13,14). In addition, recent literature also suggests that social and contextual factors are distinct mediators of outcome after a major knee joint injury, influencing all stages of recovery(15).
Evidence-informed clinical recommendations for treating persons with major knee injuries include shared-decision making starting early after injury (within days to weeks) that includes both short-term and long-term perspectives to foster autonomy and a foundation to enable informed decisions regarding their current and future knee health(16–19).
Knee injuries in Region Zealand
The annual numbers from 2019 show that 714 people visited the emergency rooms at Slagelse and Næstved Hospitals with traumatic knee injuries (432 in Slagelse, and 282 in Næstved). These numbers equate to more than two persons per day with knee injuries that required medical attention and represents a substantial caseload in the emergency room setting. Considering the high risks of long term consequences following traumatic knee joint injuries, a substantial proportion of knee-injured individuals in Region Zealand will continue on a life-long trajectory of fluctuating knee health, leading to gradually poorer physical abilities, quality of life and ultimately a knee OA diagnosis(20,21).
Core challenge
Knee injured individuals are not getting the care they need and are often left alone in dealing with the wide-ranging consequences of their knee injury, including handling emotions, coping and future worries(22–24). This is echoed by findings from a Danish sports medicine clinic, where 30% of physically active individuals with musculoskeletal injuries were classified with clinical (severe) stress, and overall, one in three expressed a likely need for psychological counseling(25). In a recent quality interview study performed by our group, we found that knee-injured individuals perceive the early care as filled with worries and unmet emotional and information support needs (unpublished data). In the same study, we found that health care professionals, despite their best intentions, need more support and training to deliver timely and appropriate care (unpublished data).
If knee-injured individuals are not sufficiently supported early, they risk entering a negative spiral of uninformed bad decisions regarding treatment, over-optimistic treatment expectations and a lack of awareness of long-term consequences of their knee injury, potentially missing out on important opportunities to engage in activities to preserve future knee joint health(26).
Besides the crucial short- and long-term role of exercise-based activities to reduce re-injuries(27), promote articular tissue health(28,29), reduce adiposity(30), improve altered movement patterns and reduce muscle weakness(31), education plays a vital role in shaping the knee-injured individuals views on the necessity of a lifespan approach to exercise and physical activity to secure future knee-related health. Early after the knee trauma, information about re-injury and risk of knee OA, realistic recovery and return-to-activity timelines as well as the lifespan importance of exercise-therapy, healthy movement patterns and weight management should be clearly communicated to the knee-injured individual(26).
Our solution is to implement and evaluate systematic, evidence-based and tailored knee-injury care delivered early after injury to young individuals with traumatic knee joint injuries

Lægmands beskrivelse

WHAT: There is currently poor implementation of contemporary research and clinical evidence in the management of traumatic knee joint injuries
WHY: There is need for and great potential in focused early action, targeting appropriate and evidence-based first-line treatment after traumatic knee joint injuries.
HOW: We will implement and evaluate systematic, evidence-based and tailored knee-injury care delivered early after injury to young individuals with traumatic knee joint injuries
Effektiv start/slut dato1/02/20 → …