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Published in: BMC Musculoskeletal Disorders 1/2022

Open Access 01-12-2022 | Anxiety | Research

Disrupted knee – disrupted me: a strenuous process of regaining balance in the aftermath of an anterior cruciate ligament injury

Authors: Josefin Karlström, Maria Wiklund, Eva Tengman

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

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Abstract

Background

Individuals describe both short and long term consequences after an anterior cruciate ligament (ACL) injury. Functional impairments are well documented while psychological, social and contextual factors need to be further investigated. By the use of a qualitative method incorporating a biopsychosocial lens, we aimed to explore individuals’ experiences of living and coping with an ACL rupture with a specific focus on experiences significant to overall life, activity in daily living and physical activity more than one year after injury.

Methods

Twelve participants were chosen strategically by a purposive sampling. Four men and eight women (19–41 years) with an ACL rupture 2–25 years ago, were included. Semi-structured interviews were used and analysed with qualitative content analysis.

Results

The results consisted of one overarching theme: ‘A strenuous process towards regaining balance’ which built on three categories ‘Disrupted knee’, ‘Disrupted me’ and ‘Moving forward with new insights’. The overarching theme captures the participants’ experiences of a strenuous process towards regaining both physical and mental balance in the aftermath of an ACL injury. The results illuminate how participants were forced to cope with a physically ‘disrupted knee’, as well as facing mental challenges, identity challenges and a ‘disrupted me’. By gradual acceptance and re-orientation they were moving forward with new insights – although still struggling with the consequences of the injury.

Conclusions

Individuals with an ACL injury experience both physical, psychological, and social challenges several years after injury. In addition to the functional impairments, diverse psychological, social and contextual ‘disruptions’ and struggles may also be present and influence the rehabilitation process. It is important that physiotherapists identify individuals who face such challenges and individually tailor the rehabilitation and support. A biopsychosocial approach is recommended in the clinical practice and future studies focusing on psychosocial processes in the context of ACL rehabilitation are warranted.
Literature
1.
go back to reference Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, Stuart MJ, Krych AJ. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med. 2016;44(6):1502–7.PubMedCrossRef Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, Stuart MJ, Krych AJ. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med. 2016;44(6):1502–7.PubMedCrossRef
2.
go back to reference Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, et al. Non-contact ACL injuries in female athletes: an international olympic committee current concepts statement. Br J Sports Med. 2008;42(6):394–412.PubMedCrossRef Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, et al. Non-contact ACL injuries in female athletes: an international olympic committee current concepts statement. Br J Sports Med. 2008;42(6):394–412.PubMedCrossRef
3.
go back to reference Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39(3):538–43.PubMedCrossRef Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med. 2011;39(3):538–43.PubMedCrossRef
4.
go back to reference Nwachukwu BU, Adjei J, Rauck RC, Chahla J, Okoroha KR, Verma NN, Allen AA, Williams RJ 3rd. How much do psychological factors affect lack of return to play after anterior cruciate ligament reconstruction? a systematic review. Orthop J Sports Med. 2019;7(5):2325967119845313.PubMedPubMedCentralCrossRef Nwachukwu BU, Adjei J, Rauck RC, Chahla J, Okoroha KR, Verma NN, Allen AA, Williams RJ 3rd. How much do psychological factors affect lack of return to play after anterior cruciate ligament reconstruction? a systematic review. Orthop J Sports Med. 2019;7(5):2325967119845313.PubMedPubMedCentralCrossRef
5.
go back to reference Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):1549–58.PubMedCrossRef Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41(7):1549–58.PubMedCrossRef
6.
go back to reference Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543–52.PubMedCrossRef Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48(21):1543–52.PubMedCrossRef
7.
go back to reference Tjong VK, Murnaghan ML, Nyhof-Young JM, Ogilvie-Harris DJ. A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play. Am J Sports Med. 2014;42(2):336–42.PubMedCrossRef Tjong VK, Murnaghan ML, Nyhof-Young JM, Ogilvie-Harris DJ. A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play. Am J Sports Med. 2014;42(2):336–42.PubMedCrossRef
8.
go back to reference Tengman E, BraxOlofsson L, Stensdotter AK, Nilsson KG, Hager CK. Anterior cruciate ligament injury after more than 20 years. II. Concentric and eccentric knee muscle strength. Scand J Med Sci Sports. 2014;24(6):e501-509.PubMedCrossRef Tengman E, BraxOlofsson L, Stensdotter AK, Nilsson KG, Hager CK. Anterior cruciate ligament injury after more than 20 years. II. Concentric and eccentric knee muscle strength. Scand J Med Sci Sports. 2014;24(6):e501-509.PubMedCrossRef
9.
go back to reference Tengman E, BraxOlofsson L, Nilsson KG, Tegner Y, Lundgren L, Hager CK. Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function. Scand J Med Sci Sports. 2014;24(6):e491-500.PubMedCrossRef Tengman E, BraxOlofsson L, Nilsson KG, Tegner Y, Lundgren L, Hager CK. Anterior cruciate ligament injury after more than 20 years: I. Physical activity level and knee function. Scand J Med Sci Sports. 2014;24(6):e491-500.PubMedCrossRef
10.
go back to reference Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014;42(9):2242–52.PubMedCrossRef Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014;42(9):2242–52.PubMedCrossRef
11.
go back to reference Filbay SR, Crossley KM, Ackerman IN. Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: a qualitative study. J Physiother. 2016;62(2):103–10.PubMedCrossRef Filbay SR, Crossley KM, Ackerman IN. Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: a qualitative study. J Physiother. 2016;62(2):103–10.PubMedCrossRef
12.
go back to reference Truong LK, Mosewich AD, Holt CJ, Le CY, Miciak M, Whittaker JL. Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review. Br J Sports Med. 2020;54(19):1149–56.PubMedCrossRef Truong LK, Mosewich AD, Holt CJ, Le CY, Miciak M, Whittaker JL. Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review. Br J Sports Med. 2020;54(19):1149–56.PubMedCrossRef
13.
go back to reference Carson F, Polman R. Experiences of professional rugby union players returning to competition following anterior cruciate ligament reconstruction. Phys Ther Sport. 2012;13(1):35–40.PubMedCrossRef Carson F, Polman R. Experiences of professional rugby union players returning to competition following anterior cruciate ligament reconstruction. Phys Ther Sport. 2012;13(1):35–40.PubMedCrossRef
14.
go back to reference Heijne A, Axelsson K, Werner S, Biguet G. Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients’ experiences. Scand J Med Sci Sports. 2008;18(3):325–35.PubMedCrossRef Heijne A, Axelsson K, Werner S, Biguet G. Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients’ experiences. Scand J Med Sci Sports. 2008;18(3):325–35.PubMedCrossRef
15.
go back to reference Thing LF. “Voices of the broken body.” The resumption of non-professional female players’ sports careers after anterior cruciate ligament injury the female player’s dilemma: is she willing to run the risk? Scand J Med Sci Sports. 2006;16(5):364–75.PubMedCrossRef Thing LF. “Voices of the broken body.” The resumption of non-professional female players’ sports careers after anterior cruciate ligament injury the female player’s dilemma: is she willing to run the risk? Scand J Med Sci Sports. 2006;16(5):364–75.PubMedCrossRef
16.
go back to reference Osterberg A, Kvist J, Dahlgren MA. Ways of experiencing participation and factors affecting the activity level after nonreconstructed anterior cruciate ligament injury: a qualitative study. J Orthop Sports Phys Ther. 2013;43(3):172–83.PubMedCrossRef Osterberg A, Kvist J, Dahlgren MA. Ways of experiencing participation and factors affecting the activity level after nonreconstructed anterior cruciate ligament injury: a qualitative study. J Orthop Sports Phys Ther. 2013;43(3):172–83.PubMedCrossRef
17.
go back to reference Nordahl B, Sjostrom R, Westin M, Werner S, Alricsson M. Experiences of returning to elite alpine skiing after ACL injury and ACL reconstruction. Int J Adolesc Med Health. 2014;26(1):69–77.PubMedCrossRef Nordahl B, Sjostrom R, Westin M, Werner S, Alricsson M. Experiences of returning to elite alpine skiing after ACL injury and ACL reconstruction. Int J Adolesc Med Health. 2014;26(1):69–77.PubMedCrossRef
18.
go back to reference Evans L, Hardy L. Injury rehabilitation: a qualitative follow-up study. Res Q Exerc Sport. 2002;73(3):320–9.PubMedCrossRef Evans L, Hardy L. Injury rehabilitation: a qualitative follow-up study. Res Q Exerc Sport. 2002;73(3):320–9.PubMedCrossRef
19.
go back to reference Scott SM, Perry MA, Sole G. “Not always a straight path”: patients’ perspectives following anterior cruciate ligament rupture and reconstruction. Disabil Rehabil. 2018;40(19):2311–7.PubMedCrossRef Scott SM, Perry MA, Sole G. “Not always a straight path”: patients’ perspectives following anterior cruciate ligament rupture and reconstruction. Disabil Rehabil. 2018;40(19):2311–7.PubMedCrossRef
20.
go back to reference Mahood C, Perry M, Gallagher P, Sole G. Chaos and confusion with confidence: managing fear of re-injury after anterior cruciate ligament reconstruction. Phys Ther Sport. 2020;45:145–54.PubMedCrossRef Mahood C, Perry M, Gallagher P, Sole G. Chaos and confusion with confidence: managing fear of re-injury after anterior cruciate ligament reconstruction. Phys Ther Sport. 2020;45:145–54.PubMedCrossRef
21.
go back to reference Pizzari T, McBurney H, Taylor NF, Feller JA. Adherence to anterior cruciate ligament rehabilitation: a qualitative analysis. J Sport Rehabil. 2002;11(2):90–102.CrossRef Pizzari T, McBurney H, Taylor NF, Feller JA. Adherence to anterior cruciate ligament rehabilitation: a qualitative analysis. J Sport Rehabil. 2002;11(2):90–102.CrossRef
22.
go back to reference Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.PubMedCrossRef Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.PubMedCrossRef
23.
go back to reference Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–9.CrossRef Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–9.CrossRef
24.
go back to reference Roos EM, Roos HP, Ekdahl C, Lohmander LS. Knee injury and Osteoarthritis Outcome Score (KOOS)–validation of a Swedish version. Scand J Med Sci Sports. 1998;8(6):439–48.PubMedCrossRef Roos EM, Roos HP, Ekdahl C, Lohmander LS. Knee injury and Osteoarthritis Outcome Score (KOOS)–validation of a Swedish version. Scand J Med Sci Sports. 1998;8(6):439–48.PubMedCrossRef
25.
go back to reference Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–72.PubMedCrossRef Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–72.PubMedCrossRef
27.
go back to reference Anderson MJ, Browning WM 3rd, Urband CE, Kluczynski MA, Bisson LJ. A systematic summary of systematic reviews on the topic of the anterior cruciate ligament. Orthop J Sports Med. 2016;4(3):2325967116634074.PubMedPubMedCentralCrossRef Anderson MJ, Browning WM 3rd, Urband CE, Kluczynski MA, Bisson LJ. A systematic summary of systematic reviews on the topic of the anterior cruciate ligament. Orthop J Sports Med. 2016;4(3):2325967116634074.PubMedPubMedCentralCrossRef
28.
go back to reference Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2013;47(17):1120–6.PubMedCrossRef Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2013;47(17):1120–6.PubMedCrossRef
29.
go back to reference Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2005;13(5):393–7.PubMedCrossRef Kvist J, Ek A, Sporrstedt K, Good L. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2005;13(5):393–7.PubMedCrossRef
30.
go back to reference Fjellman-Wiklund A, Soderman K, Lundqvist M, Hager CK. Retrospective experiences of individuals two decades after anterior cruciate ligament injury - a process of re-orientation towards acceptance. Disabil Rehabil. 2021:1–10. Epub ahead of print. Fjellman-Wiklund A, Soderman K, Lundqvist M, Hager CK. Retrospective experiences of individuals two decades after anterior cruciate ligament injury - a process of re-orientation towards acceptance. Disabil Rehabil. 2021:1–10. Epub ahead of print.
31.
go back to reference Lisee CM, DiSanti JS, Chan M, Ling J, Erickson K, Shingles M, Kuenze CM. Gender differences in psychological responses to recovery after anterior cruciate ligament reconstruction before return to sport. J Athl Train. 2020;55(10):1098–105.PubMedPubMedCentralCrossRef Lisee CM, DiSanti JS, Chan M, Ling J, Erickson K, Shingles M, Kuenze CM. Gender differences in psychological responses to recovery after anterior cruciate ligament reconstruction before return to sport. J Athl Train. 2020;55(10):1098–105.PubMedPubMedCentralCrossRef
32.
go back to reference Piussi R, Berghdal T, Sundemo D, Grassi A, Zaffagnini S, Sansone M, Samuelsson K, Senorski EH. Self-reported symptoms of depression and anxiety after ACL injury: a systematic review. Orthop J Sports Med. 2022;10(1):23259671211066492.PubMedPubMedCentralCrossRef Piussi R, Berghdal T, Sundemo D, Grassi A, Zaffagnini S, Sansone M, Samuelsson K, Senorski EH. Self-reported symptoms of depression and anxiety after ACL injury: a systematic review. Orthop J Sports Med. 2022;10(1):23259671211066492.PubMedPubMedCentralCrossRef
33.
go back to reference Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):752–62.PubMedCrossRef Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):752–62.PubMedCrossRef
34.
go back to reference Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, et al. Return to sport after anterior cruciate ligament injury: panther symposium ACL injury return to sport consensus group. Orthop J Sports Med. 2020;8(6):2325967120930829.PubMedPubMedCentralCrossRef Meredith SJ, Rauer T, Chmielewski TL, Fink C, Diermeier T, Rothrauff BB, Svantesson E, Hamrin Senorski E, Hewett TE, Sherman SL, et al. Return to sport after anterior cruciate ligament injury: panther symposium ACL injury return to sport consensus group. Orthop J Sports Med. 2020;8(6):2325967120930829.PubMedPubMedCentralCrossRef
35.
go back to reference Piussi R, Krupic F, Senorski C, Svantesson E, Sundemo D, Johnson U, Hamrin Senorski E. Psychological impairments after ACL injury - do we know what we are addressing? Experiences from sports physical therapists. Scand J Med Sci Sports. 2021;31(7):1508–17.PubMedCrossRef Piussi R, Krupic F, Senorski C, Svantesson E, Sundemo D, Johnson U, Hamrin Senorski E. Psychological impairments after ACL injury - do we know what we are addressing? Experiences from sports physical therapists. Scand J Med Sci Sports. 2021;31(7):1508–17.PubMedCrossRef
36.
go back to reference Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;2010(7):CD002014.PubMedCentral Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;2010(7):CD002014.PubMedCentral
37.
go back to reference O’Neill A, O’Sullivan K, O’Sullivan P, Purtill H, O’Keeffe M. Examining what factors mediate treatment effect in chronic low back pain: a mediation analysis of a cognitive functional therapy clinical trial. Eur J Pain. 2020;24(9):1765–74.PubMedCrossRef O’Neill A, O’Sullivan K, O’Sullivan P, Purtill H, O’Keeffe M. Examining what factors mediate treatment effect in chronic low back pain: a mediation analysis of a cognitive functional therapy clinical trial. Eur J Pain. 2020;24(9):1765–74.PubMedCrossRef
38.
go back to reference Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861–76.PubMedPubMedCentralCrossRef Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861–76.PubMedPubMedCentralCrossRef
39.
go back to reference Cronstrom A, Tengman E, Hager CK. Risk factors for contra-lateral secondary anterior cruciate ligament injury: a systematic review with meta-analysis. Sports Med. 2021;51(7):1419–38.PubMedPubMedCentralCrossRef Cronstrom A, Tengman E, Hager CK. Risk factors for contra-lateral secondary anterior cruciate ligament injury: a systematic review with meta-analysis. Sports Med. 2021;51(7):1419–38.PubMedPubMedCentralCrossRef
40.
go back to reference Antonovsky H, Sagy S. The development of a sense of coherence and its impact on responses to stress situations. J Soc Psychol. 1986;126(2):213–25.PubMed Antonovsky H, Sagy S. The development of a sense of coherence and its impact on responses to stress situations. J Soc Psychol. 1986;126(2):213–25.PubMed
41.
go back to reference Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25.PubMedCrossRef Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25.PubMedCrossRef
42.
go back to reference Kortte KB, Veiel L, Batten SV, Wegener ST. Measuring avoidance in medical rehabilitation. Rehabil Psychol. 2009;54(1):91–8.PubMedCrossRef Kortte KB, Veiel L, Batten SV, Wegener ST. Measuring avoidance in medical rehabilitation. Rehabil Psychol. 2009;54(1):91–8.PubMedCrossRef
43.
go back to reference Christino MA, Fantry AJ, Vopat BG. Psychological aspects of recovery following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2015;23(8):501–9.PubMedCrossRef Christino MA, Fantry AJ, Vopat BG. Psychological aspects of recovery following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2015;23(8):501–9.PubMedCrossRef
Metadata
Title
Disrupted knee – disrupted me: a strenuous process of regaining balance in the aftermath of an anterior cruciate ligament injury
Authors
Josefin Karlström
Maria Wiklund
Eva Tengman
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Anxiety
Published in
BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-022-05252-6

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