Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors

Abstract

Context: Return-to-sport criteria after anterior cruciate ligament (ACL) injury are often based on “satisfactory” functional and patient-reported outcomes. However, an individual's decision to return to sport is likely multifactorial; psychological and physical readiness to return may not be synonymous. Objective: To determine the psychosocial factors that influence the decision to return to sport in athletes 1 year post–ACL reconstruction (ACLR). Design: Qualitative study. Setting: Academic medical center. Patients or Other Participants: Twelve participants (6 males, 6 females) were purposefully chosen from a large cohort. Participants were a minimum of 1-year postsurgery and had been active in competitive athletics preinjury. Data Collection and Analysis: Data were collected via semistructured interviews. Qualitative analysis using a descriptive phenomenologic process, horizontalization, was used to derive categories and themes that represented the data. The dynamic-biopsychosocial model was used as a theoretical framework to guide this study. Results: Six predominant themes emerged that described the participants' experiences after ACLR: (1) hesitation and lack of confidence led to self-limiting tendencies, (2) awareness was heightened after ACLR, (3) expectations and assumptions about the recovery process influenced the decision to return to sport after ACLR, (4) coming to terms with ACL injury led to a reprioritization, (5) athletic participation helped reinforce intrinsic personal characteristics, and (6) having a strong support system both in and out of rehabilitation was a key factor in building a patient's confidence. We placed themes into components of the dynamic-biopsychosocial model to better understand how they influenced the return to sport. Conclusions: After ACLR, the decision to return to sport was largely influenced by psychosocial factors. Factors including hesitancy, lack of confidence, and fear of reinjury are directly related to knee function and have the potential to be addressed in the rehabilitation setting. Other factors, such as changes in priorities or expectations, may be independent of physical function but remain relevant to the patient-clinician relationship and should be considered during postoperative rehabilitation.

Functional Knee Performance Differences in Handball are Depending on Playing Class

“…Also, psychological aspects are not taken into account. Recent studies have shown an influence of psychological parameters on performance and progress for return to sport [31][32][33].…”

Decision to Return to Sport Participation After Anterior Cruciate Ligament Reconstruction, Part II: Self-Reported and Functional Performance Outcomes

“…Among both groups, it is apparent that numerous participants perceived they were experiencing suboptimal knee health despite a relatively high level of functional capacity as demonstrated by performance testing. Based on the responses to the PROs and the qualitative portion of this study, 44 patients appeared to experience subjective functional changes, heightened awareness, changing expectations and assumptions, and a general ''coming to terms'' with their ACL injuries. This overall process may result in individuals defining a ''new normal'' for knee function.…”

“…This hesitancy may be a clinical expression of the theme of hesitation and lack of confidence led to self-limiting tendencies identified during the qualitative portion of this investigation. 44 Whereas the dynamic functional performance values exceeded the normal limb symmetry considered acceptable for sport activity, the hesitancy expressed by participants may support the continued use of single-legged-hop assessments during late-stage rehabilitation to regain patient confidence and facilitate the transition to return to sport.…”

Retorno Deportivo Luego de Reconstrucción Primaria de Ligamento Cruzado Anterior con Injerto Hueso-Tendón Patelar-Hueso Autólogo: Análisis de Factores Relacionados

“…3,48 Además del temor a una nueva lesión, distintos autores muestran factores como la falta de confianza, la inseguridad, la motivación y un cambio en las prioridades y en las expectativas como aspectos primordiales que explican la conducta postoperatoria ante la actividad deportiva. 3, [49][50][51] Ese último punto, que vale la pena ser considerado antes de analizar fríamente las tasas de retorno deportivo, se refleja claramente en nuestro estudio en un significativo grupo de 34 pacientes (26%), que simplemente no retornaron al deporte en el periodo estudiado por motivos no relacionados a su cirugía, ni a su rodilla.…”