A n injury to the anterior cruciate ligament (ACL) causes knee instability and long absence from sports participation, or even the end of an athletic career.In addition, the injury can create feelings of uncertainty and fear of how far the injury will affect future function. 37 The extent of the impact of the injury on activity participation varies; some experience instability in daily living, while others are able to return to preinjury activity levels without reconstruction of the torn ligament. 3,5,7,13,25,31 Some can even return to pivoting sports, 4,9 but not always without symptoms and occasional episodes of instability. 23,28,29 Movement patterns, self-reported knee function, the leg symmetry index in single-leg hop tests, and quadriceps strength are factors found to differentiate between those who return to the preinjury activity level and those who do not. 1,8,9,25 The results of these studies are not consistent, because some individuals do not return, despite a high rating of knee function or a leg symmetry index T T STUDY DESIGN: Phenomenographic, crosssectional.
T T OBJECTIVES:To describe ways of experiencing participation in activities of individuals with a nonreconstructed anterior cruciate ligament injury and to describe the emotional aspects related to participation. Further, the objective was to explore factors affecting the activity level.
T T BACKGROUND:The importance of assessing different factors (knee status, muscle performance, psychological factors, performance-based tests, and subjective rating of knee function) after an anterior cruciate ligament injury has been emphasized. However, the results of these assessments do not answer the question of how the individuals themselves experience their participation in activities.
T T METHODS: Semi-structured interviewswere conducted with 19 strategically selected informants (age range, 18-43 years) who had sustained an anterior cruciate ligament injury 18 to 67 months previously. A phenomenographic approach, which describes individuals' ways of experiencing a phenomenon, was used.
T T RESULTS:Five qualitatively different categories were identified: (A) unconditioned participation, (B) participation as conditioned by risk appraisal, (C) participation as conditioned by experienced control of the knee, (D) participation as conditioned by experienced knee impairment, and (E) participation as conditioned by neglecting the knee injury. Within each category, 5 interrelated aspects were discerned: focus, level of performance, activities, strategies, and feelings. Categories A, C, and E reflected experiences of full participation, whereas categories B and D reflected experiences of modified participation. There were mostly positive feelings regarding participation. Negative feelings were expressed in category D. Factors affecting the activity level were grouped according to the framework of the International Classification of Functioning, Disability and Health and described as facilitating or hindering the activity level. Facilitating factors included reg...