JMIR Publications

ABSTRACT

Background:

Traumatic knee injuries (TKI) are common, being 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, as per the 2022 OPTIKNEE recommendations, but long-term care availability is limited. DHIs (digital health interventions) such as wearable devices, telehealth innovations and mobile apps have the potential to deliver long term musculoskeletal care. DHIs can be scaled up to support healthcare delivery by improving efficiency and accessibility.

Objective:

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

Methods:

A search of 7 online academic 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 that can support care after TKI. The content from each DHI was mapped against the seven OPTIKNEE recommendations: exercise, goal setting, patient reported outcome measures, functional assessment, strength assessment, information provision and overall clinical outcome. DHIs were then evaluated against the health-technology pathway to identify their stage of development. Lastly, adoption into routine clinical practice was analysed using Normalisation Process Theory (NPT), which considers four domains: coherence, cognitive participation, collective action and reflexive monitoring.

Results:

There were 81 reports, 53 peer-reviewed and 28 from other sources, concerning 49 distinct DHIs. 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. Across the 49 DHIs, 25 were classified as mHealth, 19 as telerehabilitation, 4 as eHealth and one as both telerehabilitation and mHealth. No DHIs addressed all the OPTIKNEE recommendations, however the eight most complete reported 4/7 components, including exercise, information provision, patient reported outcome measures, goal setting and overall patient outcome. Only one DHI reported a remote functional assessment and self-assessed strength evaluations were not reported in any DHI. NPT analysis typically demonstrated low DHI adoption across the four domains and positive responses across the four NPT domains varied across the different 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 full content recommended by OPTIKNEE to reduce the risk of PTOAK. Further, there is negligible evidence of DHIs being adopted into usual care, irrespective of the stage of DHI development. There is a clear need to develop guideline-compliant DHIs to support effective prevention.