3 People’s perceptions about their anterior cruciate ligament injury and its care - a systematic review and qualitative evidence synthesis

Introduction Understanding how people cope with the short- and long-term impacts of anterior cruciate ligament (ACL) rupture and what influences their choice of management (operative vs non-operative) is important to inform interventions that can support physical, psychological and social well-being along the recovery pathway. This review aimed to synthesise all qualitative research involving people post-ACL injury, to understand their perceptions of the injury and its care.Materials and Methods Following protocol registration, 6 databases were searched from inception to June 2024 for qualitative studies that included people post-ACL injury. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist. Extracted data were synthesised using inductive thematic analysis.Results Fifty-six studies with 806 participants (52% female, 85% with ACL reconstruction) from 12 countries were included. Overall study quality was high (21% scored 10/10; 7% scored <8/10 on the CASP checklist). Five themes were identified and were consistent across study settings and time since injury. (1) Knowledge and beliefs around injury are shaped by external messages; (2) Injury disrupted self-identity; (3) Access to individual, interpersonal and community-level support can facilitate physical and psychological recovery; (4) The psychological roller-coaster including fear of re-injury and despair; (5) Accessing the right materials for tailored, holistic care.Conclusion As the first-ever qualitative synthesis of post-ACL injury studies, our findings provide clinicians and researchers with a clinically useful framework to improve their understanding of people's perceptions, experiences, and physical and non-physical needs after ACL injury.