Traumatic knee injury healthcare pathways and outcomes: the Australian Knee Injury Inception Cohort Study (KIICS) protocol

Decision-making for the optimal management of traumatic knee injuries can be challenging. Clinical trials reveal only small differences between surgical and non-surgical approaches, while patient and clinician biases, as well as healthcare access issues, may also influence management. Little is known about the real-world healthcare pathways for patients with a knee injury, as well as the person- and/or healthcare-related factors that influence management strategies and outcomes. The Australian Knee Injury Inception Cohort Study (KIICS) aims to: (1) describe healthcare pathways following acute knee injury (including the timing and type of healthcare consultations); (2) identify patient- and/or healthcare-related predictors of management strategy (ie, surgical vs non-surgical); and (3) examine the long-term outcome of different injury types, healthcare pathways and management strategies. KIICS is a nationwide prospective longitudinal inception cohort study recruiting Australians who have sustained an acute knee injury within the previous 6 months that disrupted daily activities or sports and led to a healthcare consultation. Participants will complete online questionnaires at enrolment and at 6 months, 1, 2, 5 and 10 years post-injury. The data to be collected will include sociodemographic characteristics, knee injury history, the sequence of healthcare consultations and referral patterns, and management strategies (ie, surgical vs non-surgical). Patient-reported outcomes will include knee pain and instability, knee-related quality of life, patient-acceptable symptom state, health-related quality of life, mental health, fear of reinjury, return-to-sport status and activity level. Detailed statistical analysis plans will be developed to address the study's key research questions, informing clinical practice, shared decision-making and healthcare policy.