Summary

Mechanisms of optimism after ACL injury and surgery were identified in young athletes from two countries representing different sporting populations and healthcare systems.

Abstract

Background

The impact of anterior cruciate ligament (ACL) injuries and reconstruction (ACLR) on quality of life (QOL) is of global interest as the rate of ACL tears continue to rise in young athletes. Athletes’ QOL is traditionally assessed with patient reported outcome measures while surgical success is often based on surgical (knee stability, complications, re-injury, etc.) and return to sport outcomes. Current research using quantitative outcomes is limited in that information as to how athletes conceptualize constructs such as QOL is missing, and individual factors are not explored.

Purpose

To investigate young athletes’ experiences with ACL injury/recovery and perceived QOL one year after ACLR and to compare the experiences of Australian and Canadian athletes.

Methods

Using descriptive qualitative methodology, 13 athletes from Australia who underwent ACLR were interviewed one year following surgery using a semi-structured interview guide and QOL visual analog scale (0 to 100). Transcripts were coded by two independent researchers and organized using thematic analysis. The constructed themes were compared to themes extracted from a previous study in which 16 Canadian athletes were interviewed pre-operatively and completed similar post-operative interviews.

Results

Mean QOL scores one year after ACLR were 72 (range 50 to 96) in the Australian cohort (mean age: 21; 54% male; most common sports: Australian rules football, netball, soccer; private healthcare system) and 86 (range 75 to 98) in the Canadian cohort (mean age: 19; 50% male; most common sports: basketball, soccer, hockey; public healthcare system). An overall theme of optimism was identified in interviews with Australian athletes after ACLR. Four distinct mechanisms of optimism were identified: 1) positive expectations, 2) gratitude, 3) cognitive reframing and 4) resilience. These mechanisms mirrored the themes of “expectation of recovery” and “sport re-prioritization” in the Canadian cohort. In the initial Canadian study, gratitude was also identified but not fully explored as a theme. As part of the iterative nature of semi-structured interviewing, a question was added to interviews with Australian participants asking if they were grateful for their ACL injury. Most of the Australian athletes (8 of 13) were grateful, stating they would not take back the occurrence of the initial injury. Reasons for gratitude in both cohorts included development of resilience, time for attention to life goals outside of sport, and an increased appreciation for physical activity or sport. In both Australian and Canadian cohorts, all participants reported being satisfied with their surgery regardless of complications, rehabilitation timeline, or return to sport status. No participants had experienced a graft or contralateral ACL rupture.

Conclusions

Mechanisms of optimism after ACL injury and surgery were identified in young athletes from two countries representing different sporting populations and healthcare systems. Many athletes identified positive aspects of their ACL injury experience that they were grateful for. Traditionally held beliefs about how to define a successful ACLR may not hold true when considering humans’ innate ability to cope and adapt. This work supports the need for individualized care and novel research approaches to understand how to best treat young athletes after ACL injury.