Logerstedt, David

Abstract A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.

Background Knee injuries are prevalent in cutting, pivoting, and jumping sports. Studies have investigated the effects of exercise-based knee injury prevention programs, however no clinical practice guidelines (CPG) exist. Objective 1) Review the evidence for exercise-based knee injury prevention programs, 2) identify if there are exercise-based knee injury prevention programs that are effective for particular groups of athletes, 3) explore the evidence for dosage and delivery of exercise-based knee injury prevention programs, 4) provide information on how exercise-based knee injury prevention should be implemented. Design Systematic review for CPG development. Setting Multiple. Patients (or Participants) Healthy, active individuals, particularly athletes participating in cutting, pivoting, and jumping sports. Interventions (or Assessment of Risk Factors) A systematic review of literature was performed via PubMed, Scopus, SportDiscus, CINAHL, and the Cochrane databases for relevant articles addressing the effects of an exercise-based knee injury prevention program. The final search was performed in April, 2016 to identify all articles published prior to that point. Main Outcome Measurements The effects and outcomes of exercise-based knee injury prevention programs. Results Thirty-seven studies met the inclusion criteria for this CPG. Exercise-based knee injury prevention programs have a low implementation cost and large relative risk reductions. Clinicians should implement an exercise-based knee injury prevention program for all athletes involved in cutting and pivoting type sports to reduce the number of significant knee injuries. The program should be implemented two to three times per week in the preseason and one to three times per week in the competitive season. It should consist of a combination of plyometric training, strength and power exercises, balance and dynamic stabilization training, core strengthening, technique training, and/or sports-specific drills. Conclusions This CPG will provide evidence based guidance for clinicians in choosing and implementing exercise-based knee injury prevention programs appropriate for the athlete(s) they work with.