Athletic Trainers’ Knowledge and Perceptions of Posttraumatic Osteoarthritis
After Knee Injury

BG, Blackburn JT, Golightly YM, Harkey MS, Luc BA, DeFreese JD, Padua DA,
Jordan JM, & Bennell KL.  J Athl Train. Published Online
First: March 10, 2016. doi: 10.4085/1062-6050-51.2.13

Take Home Message: Athletic trainers are familiar with
osteoarthritis, but less familiar with posttraumatic osteoarthritis.  This knowledge seems to come with years of
experience in the field. 

have had many posts on Sports Med Res
about the long-term consequences of knee injuries (for example, osteoarthritis).
However, many athletic trainers and other healthcare professionals are focused
on the current health of a patient (for example, preventing or treating an
injury) and neglect long-term health concerns like the early onset of
osteoarthritis after an injury (posttraumatic osteoarthritis [PTOA]). The
NATA’s initial commitment to the
Chronic Osteoarthritis Management Initiative was to “Incorporate OA into education
components for early career practitioners; note role of athletic trainers as
gatekeepers” but it remains unknown as to whether or not athletic trainers
(ATs) are knowledgeable about osteoarthritis and its treatment after knee
injury.  Therefore, the authors of this cross-sectional
survey study aimed to evaluate the knowledge and perceptions of PTOA in 2000
randomly sampled ATs.  Among 437 (22%)
ATs who completed the survey, about 85% correctly
identified the osteoarthritis definition; however, only 60% of respondents were
familiar with PTOA.  The majority of ATs
believed that patients with a history of meniscal injury/surgery or anterior
cruciate ligament injury had a greater risk for PTOA but they underestimated
the percentage of patients who would develop osteoarthritis in the first decade
or two after these injuries.  ATs also
overestimated the protective benefits of surgery after an injury. About 70 to
80% of ATs discussed the risk and strategies to mitigate the risk of PTOA with
their patients. Only about 40% of ATs felt a patient having knee osteoarthritis
was a major health concern. The authors discovered that an AT with more years
of experience was more likely to have PTOA knowledge compared with an AT with
less clinical experience.  Also, a
previous personal history of a knee injury did not increase the percentage of
ATs aware of PTOA.

findings of this study are interesting because these authors confirm that knowledge
about the definition of osteoarthritis is relatively good, but that there is
still education needed regarding PTOA within an AT population.  It is interesting that there is an increase
in PTOA knowledge among ATs with more years of experience.  The assumption being that clinicians may be
“picking it up as they go” along in their career based on their experiences or
attendance at symposia, and that they are not necessarily learning this in
formal education programs.  The findings
of this study could help inform athletic training education programs of a need to
incorporate PTOA into curricula, similar to the integration of long-term
effects of concussions.  It appears that
ATs are overestimating the protective nature of ACL or meniscal surgery.  This is interesting because previous research
has shown that ACL reconstruction is not protective against the development of
PTOA.  Many patients will turn to ATs for
guidance after a knee injury, and if the AT is not appropriately educated in
this area, it could lead to misinformed decisions and a loss of trust.  It would be interesting to see what the
relationship of PTOA knowledge/education is to the use of primary or secondary
prevention strategies in the clinical services of the ATs surveyed.  Ultimately, ATs have a general knowledge of
OA, but there is more education needed in PTOA. 
This will only help the patients that we deal with regularly.

for Discussion:  What are some things you
advise your patients after a knee injury? 
What do you think are some successful strategies for educating ATs and
other sports medicine professions – who are populations who typically do not
think about long-term management?

Nicole Cattano
by: Jeffrey Driban


Does anterior cruciate ligament reconstruction lead to degenerative disease?  Thirteen-year results after bone-patellar tendon-bone autograft

Pietrosimone BG, Blackburn JT, Golightly YM, Harkey MS, Luc BA, DeFreese JD, Padua DA, Jordan JM, & Bennell KL (2016). Certified Athletic Trainers’ Knowledge and Perceptions of Posttraumatic Osteoarthritis After Knee Injury. Journal of Athletic Training PMID: 27145097