Six-year course and prognosis of traumatic knee symptoms in general practice: Cohort study

Abstract

KEY MESSAGESTraumatic knee symptoms in general practice seem to become a chronic disorder in one of three patients. Having knee symptoms at one-year follow-up is an important predictor of persistent symptoms at six-year follow-up. Several prognostic factors assessed at baseline are associated with persistent knee symptoms at one and sixyear follow-up. ABSTRACTBackground Traumatic knee symptoms are frequently seen, however, evidence about the course and prognostic factors are scarce. Objectives To describe the one and six-year course of traumatic knee symptoms presenting in general practice, and to identify prognostic factors for persistent knee symptoms. Methods Adolescents (12 years) and adults with traumatic knee symptoms (n ¼ 328) from general practice were followed for six years with self-report questionnaires and physical examination. Results Persistent knee symptoms were reported by 27% of the patients at one year and by 33% at six years. There was a strong relationship (OR: 11.0, 95% CI: 5.0-24.2) between having persistent knee symptoms at one year and at six-year follow-up. Prognostic factors associated with persistent knee symptoms at one year were age, poor general health, history of non-traumatic knee symptoms, absence floating patella and laxity on the anterior drawer test (AUC: 0.72). At six-year follow-up, age, body mass index427, non-skeletal co-morbidity, self-reported crepitus of the knee, history of non-traumatic knee symptoms, and laxity on the anterior drawer test were associated with persistent knee symptoms (AUC: 0.82). Conclusion Traumatic knee symptoms in general practice seem to become a chronic disorder in one out of three patients. Several prognostic factors assessed at baseline were associated with persistent knee symptoms at one and six-year follow-up.

Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis‐generating study

“…Many studies have evaluated prognostic factors of the long-term clinical course of knee OA in general practice. These studies found that factors such as age, BMI, physical impairment measures and psychosocial factors hold prognostic value for knee OA (Alschuler et al, 2013;Belo et al, 2009;Holla et al, 2010Holla et al, , 2014Kastelein et al, 2016;Van Dijk et al, 2010). To date, only one CPR study from the knee OA literature sought to identify characteristics of people with knee OA who respond favourably to a specific treatment, in this case hip joint mobilization (Currier et al, 2007).…”

Prognostic factors associated with changes in knee pain outcomes, identified from initial primary care consultation data. A systematic literature review

“…Collection of outcome measures ranged from 54 months [ 26–28 ] to 3 months [ 24 – 26 , 29 ]. Follow-up frequency ranged from five follow up time points in three studies [ 24 , 26 , 28 ], two in two studies [ 27 , 31 ] and one in the remaining three studies [ 25 , 30 , 32 ].…”

“…One study reported on co-morbidities [ 24 ]. Knee symptoms and signs were investigated in all eight studies; frequently reported were knee pain level [ 24–31 ], Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness and function questionnaire [ 24–27 ], duration of knee symptoms [ 25 , 26 , 29 , 31 ] presence of locking [ 25 , 27 , 28 , 30 ] and symptoms of giving way [ 25 , 27 , 28 , 30 ]. Physical examination factors were reported in five studies [ 25 – 26 , 28 , 30 ] and frequently included palpable warmth [ 24 – 26 ], presence of a joint effusion [ 26 , 28 , 29 ], and collateral ligament testing [ 25 , 26 , 28 ].…”

“…Another termed ligament testing as instability [ 27 ]. Six studies investigated patient characteristics which commonly related to sport participation [ 25 , 28 ] paid employment [ 28 , 31 ] and marital status [ 29 , 31 ].…”

“…Psychosocial factors were investigated in all eight studies, although some specific factors were reported in only one study. Education level was the most frequent reported factor [ 24 – 26 , 28 , 31 ]. Three studies investigated coping strategies with pain [ 24 , 31 ] and fear of movement [ 31 ] using the six subscales from the pain coping inventory (PCI) and the Tampa Scale for Kinesiophobia respectively.…”