title: A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction: to play or not to play.
abstract: BACKGROUND
  Primary anterior cruciate ligament (ACL) reconstruction is known to have excellent outcomes, but many patients do not return to their preinjury level of sport participation. Previous studies have used subjective outcome scores to evaluate this discrepancy, but none to date has used qualitative, in-depth patient interviews.
  
  
  OBJECTIVE
  To understand the factors influencing a patient's decision to return to his or her preinjury level of sport after ACL reconstruction.
  
  
  OBJECTIVE
  Extrinsic and intrinsic factors may affect one's decision to return to sport after primary ACL reconstruction despite good functional knee scores.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  An experienced interviewer conducted qualitative, semistructured interviews of 31 patients, aged 18 to 40 years, who had undergone primary ACL reconstruction surgery. All participated in sport before injury and had a minimum 2-year follow-up with no further surgeries or knee injuries. Qualitative analysis was then performed to derive codes, categories, and themes. An assessment of preinjury and current sport participation by type, level of competition, and Marx activity score, along with patient-reported knee function, was also conducted.
  
  
  RESULTS
  Patient interviews revealed 3 overarching themes: fear, lifestyle changes, and innate personality traits. Elements of these factors were shown to largely influence the decision to return to the preinjury sport both in those patients who had returned and those who had not returned to sport. Less common factors included the surgeon's advice not to return, depressed mood, and persistent knee pain.
  
  
  CONCLUSIONS
  Patients who did not return to their preinjury level of sport after primary ACL reconstruction despite having good knee function were largely influenced by fear, shifts in priority, and individual personalities. This study highlights the importance for treating physicians to recognize and address psychological factors and lifestyle changes that largely contribute to a patient's postoperative decision to return to sport. Results from this study will allow surgeons and health care professionals to educate patients contemplating surgery and to better understand the recovery process not only from sport-related surgeries but other surgical interventions with the goal of returning to activity.
authors.affiliation: Vehniah K. Tjong, Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508A, Toronto, ON M5T 1P5, Canada. vtjong@gmail.com.
authors.forename: Vehniah K
authors.initials: VK
authors.lastname: Tjong
authors.forename: M Lucas
authors.initials: ML
authors.lastname: Murnaghan
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Nyhof-Young
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Ogilvie-Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001265:Athletic Injuries / Q000523:psychology* / Q000601:surgery*; D003657:Decision Making; D005239:Fear; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D010551:Personality; D036301:Qualitative Research; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors
keywords: anterior cruciate ligament reconstruction; fear of reinjury; qualitative interviews; return to sport