JMIR Publications

ABSTRACT

Background:

Traumatic knee injuries (TKI) are common, associated with a 4-6 times increased risk of post-traumatic knee osteoarthritis (PTOAK) over the subsequent 15–20 year period. There is clear evidence that risk can be reduced, but long-term care availability is limited, prompting the development of DHIs (digital health interventions) such as wearable devices, telehealth innovations and mobile apps.

Objective:

To evaluate existing DHIs against the OPTIKNEE consensus guidelines for PTOAK prevention and investigate adoption into practice.

Methods:

A search of 7 online databases and the grey literature was completed from inception to 03/06/2025, complemented by hand searching government, charity and university websites for reports and technical prototype papers concerning DHIs to support care after TKI. DHI features were mapped to the OPTIKNEE recommendations, evaluated against the health-technology pathway to identify development stage, and implementation analysed using NPT (Normalisation Process Theory).

Results:

81 reports, 53 peer-reviewed and 28 other, concerning 49 distinct DHIs were found. They were designed for injuries of the anterior cruciate ligament (ACL, n=12); ACL meniscus (n=15); meniscus (n=3); ACL or meniscus (n=2), bone (n=2), patella dislocation (n=1), and 14 were non-specific. No DHIs addressed all OTPIKNEE recommendations, however the eight most complete reported 4/7 components, including exercise, information provision, patient reported outcome measures, goal setting and overall patient outcome. A remote, self-assessed strength evaluation was not reported in any DHI. NPT analysis typically demonstrated low DHI adoption levels, and no clear correlation with health technology pathway stage. The DHI with the highest adoption into routine practice, according to NPT, was ‘getUbetter’ with 56% positive scores.

Conclusions:

There are many available, or developing, DHIs but none include the content recommended by OPTIKNEE to reduce the risk of PTOAK. Further, there is negligible evidence of DHIs being adopted into usual care. There is a clear need to develop guideline-compliant DHIs to support effective prevention.