Table VII.

Research recommendations

Consideration	Recommendation
1. General	□ To best define populations to be included in studies, further work is needed to understand relative risk of OA in different injury types, identifying ○ Injuries which are easily defined and categorized and are at high risk of OA ○ Injuries for which this risk is likely to be reversible ○ Injuries particularly suited to different types of intervention □ Further work to enable prediction/stratification of individual risk of future OA at the time of injury, using clinical factors imaging and/or molecular biomarker profiling is needed ○ These predictors should be examined alone but also in combination □ Further work on defining the appropriate time-window for intervention after joint injury is needed ○ This may differ depending on the nature of the proposed intervention and the population studied
2. Pre-clinical studies	□The analogous nature of animal models of post-traumatic OA was highlighted, and the potential to therefore support translational interventional studies in human □Animal models or experimental medicine studies in human should be used to define the likely best delivery of an intervention, its optimal time-window and initial pharmacokinetics, to support future clinical trials
3. Preparation for translation	□Patient and public involvement should be sought, particularly around areas of assessing risk of disease, risk of harm, risk of overtreatment and acceptability of different types of proposed interventions □Feasibility studies are encouraged to address questions specific to an intervention, acceptability to patients, and refine best outcomes. Findings should be published, to enable shared knowledge.
4. Outcomes	□Better evidence for the modality and timing of early imaging as an outcome measure is needed □Evidence to support the use of surrogate outcomes of efficacy is needed: clinical/PROMs-based, imaging-based or biomarker-based, linking these early outcomes to later disease risk □Evidence for the recommendation of one or more PROMs with the best utility in this area should be sought □ Longer observational/cohort/clinical trials should be designed to collect information on: ○ natural history of joint trauma and outcomes ○ utility of molecular biomarkers ○ relationship between PROMs, biomarkers and imaging outcomes ○ relationship between early outcomes (at 1 or 2 years) and later outcomes at 5–10 years □Close liaison with industry and with regulatory authorities on the areas of outcomes research and clinical need is advised to achieve an indication in this area