Digital Health Interventions to Prevent Posttraumatic Arthritis After Traumatic Knee Injury: Scoping Review
Journal of Medical Internet Research ·
Background: Traumatic knee injuries (TKI) are common and are associated with a 4 to 6 times increased risk of posttraumatic knee osteoarthritis (PTOAK) over the subsequent 15- to 20-year period. There is clear evidence that the risk can be reduced, as per the 2022 OPTIKNEE recommendations, but long-term care availability is limited. Digital health interventions (DHIs), 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 health care delivery by improving efficiency and accessibility. Objective: This study aimed to evaluate existing DHIs against the OPTIKNEE consensus guidelines for PTOAK prevention and to investigate adoption into practice. Methods: A search of 7 online academic databases and the gray literature was completed from inception to June 3, 2025, complemented by hand searching government, charity, and university websites for reports and technical prototype papers concerning DHIs that can support care after TKIs. The content from each DHI was mapped against the 7 OPTIKNEE recommendations as follows: 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. Finally, adoption into routine clinical practice was analyzed using Normalization Process Theory (NPT), which considers 4 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 nonspecific. Across the 49 DHIs, 25 were classified as mobile health, 19 as telerehabilitation, 4 as eHealth, and 1 as both telerehabilitation and mobile health. No DHIs addressed all the OPTIKNEE recommendations; however, the 8 most complete reported 4 out of 7 components, including exercise, information provision, patient-reported outcome measures, goal setting, and overall patient outcomes. Only 1 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 4 domains, and positive responses across the 4 NPT domains varied across the different health technology pathway stages. The DHI with the highest adoption into routine practice, according to NPT, was “getUbetter,” with 56% (n=9) 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. Furthermore, 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.