Understanding Fear after an Anterior Cruciate Ligament Injury: A Qualitative Thematic Analysis Using the Common-Sense Model

Abstract

Fear is a significant factor affecting successful return to sport following an anterior cruciate ligament (ACL) injury. However, there is a lack of understanding of the emotional drivers of fear and how fear beliefs are formed. This study qualitatively explored the contextual and emotional underpinnings of fear and how these beliefs were formed, with reference to the Common-Sense Model of Self-Regulation. Face-to-face online interviews were conducted with ACL-injured participants (n = 18, 72% female) with a mean age of 28 years (range 18–50 years). Participants were either 1 year post ACL reconstruction surgery (n = 16) or at least 1 year post injury without surgery (n = 2) and scored above average on a modified Tampa Scale of Kinesiophobia. Four participants were playing state-level sport or higher. Five themes emerged describing factors contributing to fear: ‘External messages’, ‘Difficulty of the ACL rehabilitation journey’, ‘Threat to identity and independence’, ‘Socioeconomic factors’, and ‘Ongoing psychological barriers’. A sixth theme, ‘Positive coping strategies’, provided insight into influences that could reduce fear and resolve negative behaviors. This study identified a broad range of contextual biopsychosocial factors which contribute to fear, supporting the notion that ACL injuries should not be treated through a purely physical lens. Furthermore, aligning the themes to the common-sense model provided a conceptual framework conveying the inter-related, emergent nature of the identified themes. The framework provides clinicians with a means to understanding fear after an ACL injury. This could guide assessment and patient education.

The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction

“…Patients’ descriptions of feelings include: burden, worry, frustration, hopelessness, devastation, and isolation. 23,30,36,52,68 Mental health conditions, such as anxiety and depression, may increase in severity in response to injury and be detrimental to outcomes. 46 Schaffer et al 58 observed outcomes of patients stratified into 3 cohorts: clinical diagnosis of depression, situational depression, and no depression.…”

“…Further, diminished mobility often affects social interactions, shifting perception and expectations among friends and strangers. 23,30 Patients may reevaluate their lives, choosing family, work, and education commitments as greater priorities. 23,33 Psychosocial Influences on RTS It is understood that the criteria for RTS is inconsistent.…”

Reha nach Kreuzbandruptur: Rückkehrbereitschaft in den Sport evaluieren

“…Die erfolgreiche Rückkehr zum Sport scheint eng mit der Reduktion maladaptiver, protektiver Bewegungsmuster sowie der Genesungserwartung, der mentalen Gesundheit und der funktionellen Leistungsfähigkeit verknüpft zu sein [7][23] [25]. Für den Übertrag auf die Praxis ist es daher wichtig zu verstehen, dass sich physische, psychische, soziale und kontextuelle Faktoren gegenseitig beeinflussen und somit im Reha-Prozess mitbetrachtet werden müssen [17] [18].…”

‘It’s just my knee’: a qualitative study investigating the process of reframing and young athletes’ perceived quality of life between anterior cruciate ligament injury and surgery

“…In comparison to the vast body of quantitative work, there are few qualitative studies investigating the experiences of individuals following ACL injury, and most focus on experiences related to rehabilitation, return to sport and fear of reinjury 12–21. We could only find one study which investigated individuals’ perceptions of QOL after ACL injury, however, this study was conducted after participants had undergone ACL reconstruction 22.…”