Disrupted knee – disrupted me: a strenuous process of regaining balance in the aftermath of an anterior cruciate ligament injury

Abstract

Background Individuals describe both short and long term consequences after an anterior cruciate ligament (ACL) injury. Functional impairments are well documented while psychological, social and contextual factors need to be further investigated. By the use of a qualitative method incorporating a biopsychosocial lens, we aimed to explore individuals’ experiences of living and coping with an ACL rupture with a specific focus on experiences significant to overall life, activity in daily living and physical activity more than one year after injury. Methods Twelve participants were chosen strategically by a purposive sampling. Four men and eight women (19–41 years) with an ACL rupture 2–25 years ago, were included. Semi-structured interviews were used and analysed with qualitative content analysis. Results The results consisted of one overarching theme: ‘A strenuous process towards regaining balance’ which built on three categories ‘Disrupted knee’, ‘Disrupted me’ and ‘Moving forward with new insights’. The overarching theme captures the participants’ experiences of a strenuous process towards regaining both physical and mental balance in the aftermath of an ACL injury. The results illuminate how participants were forced to cope with a physically ‘disrupted knee’, as well as facing mental challenges, identity challenges and a ‘disrupted me’. By gradual acceptance and re-orientation they were moving forward with new insights – although still struggling with the consequences of the injury. Conclusions Individuals with an ACL injury experience both physical, psychological, and social challenges several years after injury. In addition to the functional impairments, diverse psychological, social and contextual ‘disruptions’ and struggles may also be present and influence the rehabilitation process. It is important that physiotherapists identify individuals who face such challenges and individually tailor the rehabilitation and support. A biopsychosocial approach is recommended in the clinical practice and future studies focusing on psychosocial processes in the context of ACL rehabilitation are warranted.

Some, but not all, patients experience full symptom resolution and a positive rehabilitation process after ACL reconstruction: an interview study

“…More than 20 years after ACL injury, patients appear to still report struggle with difficult decisions, such as whether to participate or not in different physical activities, and end up being less physically active [ 7 ]. To regain physical and mental balance after an ACL injury has been reported by patients as a difficult and long process, full of physical and mental challenges [ 12 ]. Assistance in accepting the life adaptations imposed by the knee might be warranted during rehabilitation after ACL injury/reconstruction.…”

Bewegungsängste lösen – Expositionstherapie nach VKB-Ruptur

“…In diesem Zusammenhang ist von großer Bedeutung, dass viele Sportler*innen ihr Selbstwertgefühl in einem hohen Maß durch die Partizipation und die Anerkennung innerhalb des Sports erfahren. Eine Sportkarenz geht daher fast immer mit einer Herabsetzung der eigenen Wertschätzung bis hin zum Verlust der eigenen Identität einher 22 , 23 .…”

Warum wir einen psychologisch informierten Ansatz in der Rehabilitation von VKB-Verletzungen brauchen!

“…Der Kontext, z. B. Unterstützung durch die Familie, Freunde, Sportkameraden, aber auch das therapeutische Team und das Gesundheitssystem spielen dabei als Moderator eine gewichtige Rolle 36 , 62 , 64 .…”

“…Gerade Letzteres wird von vielen Patient*innen als Schlüssel für eine erfolgreiche Rehabilitation angesehen und muss nicht zwangsläufig durch die Rückkehr in den Sport definiert sein. In manchen Fällen kommt es zu einer Neubewertung der eigenen Situation und Identität, und andere Lebensziele werden in den Mittelpunkt gestellt 36 , 57 , 60 , 77 .…”

“…In diesem Zusammenhang ist von großer Bedeutung, dass viele Sportler ihr Selbstwertgefühl in einem hohen Maß durch die Partizipation und die Anerkennung innerhalb des Sports erfahren. Eine Sportkarenz geht daher fast immer mit einer Herabsetzung der eigenen Wertschätzung bis hin zur Zerstörung der eigenen Identität einher [36] [61].…”