Preferences for post-traumatic osteoarthritis prevention strategies in individuals with anterior cruciate ligament injury.

Abstract

Objectives: There is growing interest in evaluating new strategies to delay or prevent post-traumatic osteoarthritis (PTOA) in individuals who have sustained anterior cruciate ligament (ACL) injury. This study sought to determine characteristics of potential treatments that are acceptable to patients with ACL injury.

Methods: Participants with a history of ACL injury were recruited from Reddit, Facebook, and ResearchMatch.org. After consent and eligibility confirmation, participants completed a survey comprised of questions on 1) demographics, 2) PTOA perceptions, 3) perceived PTOA risk, and 4) a discrete choice experiment (DCE) task. The DCE assessed treatment attributes including risk reduction, side effects, benefits, and out-of-pocket costs. In several scenarios, participants chose between two hypothetical treatments with various attributes or no treatment. The data were analyzed with multinomial logit, mixed logit, and latent class models.

Results: We enrolled 273 participants (median age 30.6 years [IQR: 27-33], 63% female, mean BMI=25.5 kg/m²). Of these, 29% experienced daily knee pain and 35% reported being very or extremely worried about knee OA. The two most influential attributes affecting treatment acceptability were monthly cost and potential mild side effects. Two preference phenotypes emerged: Class 1 members (n=162, 59%) generally favored treatment, prioritizing effectiveness and injections but were deterred by high cost. Class 2 members (n=111, 41%) were less inclined to use treatments with potential mild side effects and high cost.

Conclusions: These results can be used to develop tailored recruitment messaging for future trials. Messaging should emphasize how to manage side effects and out-of-pocket costs.