Background.
Women are increasingly sustaining significant knee injuries, particularly young women. Last year, over 100,000 women experienced some form of significant knee trauma in Aotearoa New Zealand (AoNZ). After injury, women are 2 to 3 times more likely to be inactive and have an increased risk of developing post-traumatic osteoarthritis (PTOA) compared to uninjured women. PTOA makes up two-thirds of all female knee arthritis and can manifest from six years post injury. Consequently, women may be navigating impacts of PTOA for most of their adulthood. While there are concerted efforts to prevent knee injury for women, no research has yet explored the impact significant knee injury has on the lives of New Zealand women. A thorough understanding of this experience would help to enhance the long-term outcomes for women after significant knee injury.

Purpose.
We aimed to explore how women in AoNZ navigate life after a significant knee injury.

Methods.
This interpretive descriptive qualitative study purposively recruited 18 women from across AoNZ with experienced of significant knee injury to participate in semi-structured interviews. Data were analysed using Reflexive Thematic Analysis.

Results.
Key themes were created, including “The invisible burden”, which highlights the constant consideration of their knee, long after their knee had healed; “Navigating without a map”, which reflects the guesswork and confusion surrounding how to care for their knee/s after acute treatment ends; and “Pain not taken seriously”, which describes how women felt their pain was often not treated with respect and empathy.

Conclusions.
This study provides valuable insight into the experiences, attitudes and beliefs of a diverse group of 18 women after significant knee injury .

Implications.
These findings help to understand the impact that significant knee injury has on women’s lives. Subsequently this information will help inform future programmes and policies for long-term knee injury management.

Background: People with knee osteoarthritis (PKOA) frequently exhibit altered gait biomechanics such as changes in spatiotemporal parameters that lead to changes in function. Hence, improving gait could be an important strategy for treating PKOA due to its functional relevance. Exercise therapy (ExT) and manual therapy (MT) are recommended interventions for the management of knee OA. However, the overall strength of evidence about the effect of physiotherapy interventions [ExT, MT, and combined intervention (ExT + MT)] on gait biomechanics in PKOA is unclear.

Objective: To investigate the effect of physiotherapy interventions on gait biomechanics in PKOA.

Methods: Prospective systematic review (PROSPERO) reg. (CRD42023408884). Literature search was done using CINAHL, Cochrane, EMBASE, Medline, Scopus, and Web of Science from inception through to March 2023, updated in Feb 2024. We included studies of any design that has reported the effect of physiotherapy on at least one biomechanical outcome in level walking in PKOA. The risk of bias was assessed.

Results: A total of 19 RCTs, two case-control and 11 single-arm studies were included in the review. 14 studies were included for meta-analysis which showed: effect measure [95% confidence interval (CI)] toe-out in stance -0.07 (-1.88, 1.74), stride length -1.29 (-5.98, 3.40), cadence -0.19 (-7.56, 7.18) knee extension moment -0.35 (-0.86, 0.17), hip flexion moment -0.16 (-0.57, 0.25), hip adduction moment -0.02 (-0.52, 0.48), and hip extension moment -0.07 (-0.48, 0.34) could be influenced by ExT. Very-low to moderate certainty of evidence found on Grading of Recommendations Assessment, Development and Evaluation criteria.

Conclusion: Very-low-to-moderate quality evidence from a small number of studies suggests that gait biomechanics may be influenced by ExT. Evidence is lacking on whether MT or MT + ExT could influence gait biomechanics in PKOA.

Implications: Exercise therapy could be a conservative tool to influence gait biomechanics while acknowledging its limitations.