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. 2018 May;53(5):452-463.
doi: 10.4085/1062-6050-313-16. Epub 2018 Mar 5.

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

Julie P Burland  1 , Jenny Toonstra  2 , Jennifer L Werner  3 , Carl G Mattacola  4 , Dana M Howell  5 , Jennifer S Howard  6
Affiliations

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

Julie P Burland et al. J Athl Train. 2018 May.

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.

Keywords: athletes; knee; psychology.

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Figures

Figure 1
Figure 1
The dynamic biopsychosocial model as developed by Wiese-Bjornstal et al. Weise-Bjornstal DM, Smith AM, Shaffer SM, Morrey MA. An integrated model of response to sport injury: psychological and sociological dynamics. J Appl Sport Psychol. 1998;10(1):46–69. Copyright © the Association for Applied Sport Psychology, www.appliedsportpsych.org, adapted by permission of Taylor & Francis Ltd, http://www.tandfonline.com on behalf of the Association for Applied Sport Psychology.
Figure 2
Figure 2
Dynamic biopsychosocial model and corresponding themes, based on the biopsychosocial model developed by Wiese-Bjornstal et al. Abbreviation: ACL, anterior cruciate ligament. Weise-Bjornstal DM, Smith AM, Shaffer SM, Morrey MA. An integrated model of response to sport injury: psychological and sociological dynamics. J Appl Sport Psychol. 1998;10(1):46–69. Copyright © the Association for Applied Sport Psychology, www.appliedsportpsych.org, adapted by permission of Taylor & Francis Ltd, http://www.tandfonline.com on behalf of the Association for Applied Sport Psychology.
See this image and copyright information in PMC

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