“I don't opt out of things because I think I will get a sore knee, but I don't expose myself to stupid risks either”: patients’ experiences of a second ACL injury—an interview study

Abstract

Purpose The purpose of this qualitative study was to describe women’s experiences with anterior cruciate ligament reconstruction (ACLR) and a subsequent ACL rupture, and to identify potential facilitators and barriers for coping with rehabilitation after the second injury. Methods Eight women between 17 and 36 years (mean 26, SD 6.5) who had experienced ACLR, followed by another ACL rupture, participated in the study. Semi-structured interviews were conducted, and data were analyzed using qualitative content analysis. Results One overarching theme, “Rehabilitation after a second ACL injury—A lifelong adaptive coping process”, emerged from analyses. Undergoing a second rehabilitation is described as a process of adaptation, beginning with the first injury and still ongoing, more than 5 years later. Participants applied different coping strategies to adapt to these life-altering injuries, but the common denominator was of major life adjustments with no return to previous activity levels. Initially, after the reinjury, it was about coping with the catastrophe of the dreaded second injury. Over time, they accepted their “new” life and reset their recovery/rehabilitation goal not just as “return to sport” but rather as a “personal life goal”. Conclusion Undergoing a second ACL injury is a long process that challenges the patient’s coping skills. Given these results, rehabilitation programs need to be more person centred according to the patients-adjusted life goals. Level of evidence 3.

‘I was young, I wanted to return to sport, and re-ruptured my ACL’ – young active female patients’ voices on the experience of sustaining an ACL re-rupture, a qualitative study

“…In our study, several of the included patients were treated with an ACL revision and returned to pre-injury level of sport. Furthermore, our main results where patients expressed personal growth and strength as an outcome of the injury process were not reported by Heijne et al [39]. These differences can be related to the patients in our study being substantially younger (16-23 years compared with 17-36 years).…”

“…There are similarities in patient's experiences in our results and results presented by Heijne et al [39], where patients experienced the first injury as more difficult to cope with compared with the second ACL injury, due to lack of knowledge and difficulties in setting expectations, and all patients experienced the rehabilitation as time-consuming. On the other hand, there were differences between the studies, where patients in Heijne et al [39] changed their goals for rehabilitation between the first or the second ACL injury, where returning to sport was changed to returning to a normal life. In our study, several of the included patients were treated with an ACL revision and returned to pre-injury level of sport.…”

“…Experiences of women suffering a second ACL injury have been previously described, where women expressed that the rehabilitation after the second ACL injury as a lifelong adaptive coping process sometimes without the possibility of returning to previous activity levels [39]. There are similarities in patient's experiences in our results and results presented by Heijne et al [39], where patients experienced the first injury as more difficult to cope with compared with the second ACL injury, due to lack of knowledge and difficulties in setting expectations, and all patients experienced the rehabilitation as time-consuming. On the other hand, there were differences between the studies, where patients in Heijne et al [39] changed their goals for rehabilitation between the first or the second ACL injury, where returning to sport was changed to returning to a normal life.…”

Sports

“…An interesting qualitative study from Stockholm (Sweden) looked at the factors that impact patients after revision anterior cruciate ligament (ACL) surgery. 1 In this reflective study, eight females who underwent failed ACL reconstruction participated in semi-structured interviews and qualitative content analysis. Patient-reported themes included reflection on how they adjusted to their life-changing injuries, and how their goals were much more personalized.…”

“…If we do not work out what is important to our patients, how can we know what we should be striving for in terms of clinical outcomes, who has had a good outcome, and where to direct our research? An interesting qualitative study from Stockholm (Sweden)looked at the factors that impact patients after revision anterior cruciate ligament (ACL) surgery 1. In this reflective study, eight females who underwent failed ACL reconstruction participated in semi-structured interviews and qualitative content analysis.…”