Fear of re-injury and other intrinsic factors are associated with return to sport after anterior cruciate ligament reconstruction

Ross, Cheryl Anne (2015-04)

Thesis (MScPhysio)--Stellenbosch University, 2015.

Thesis

ENGLISH ABSTRACT: The anterior cruciate ligament is the most commonly injured ligament in the knee, with only one third of athletes returning to their pre-injury level of sport. Identifying intrinsic factors associated with an increased likelihood of return to sport may improve the surgical outcome. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. The objective was to systematically appraise publications describing intrinsic factors which may be associated with return to sport, after anterior cruciate ligament reconstruction. A comprehensive eligibility checklist was composed. Methodological quality appraisal of cohort studies revealed that high quality studies were included in the review. A descriptive synthesis of the findings associating intrinsic factors with return to sport was performed. Ten studies were included. The most important finding was the association of fear of re-injury preventing return to sports participation. Knee function did not always correspond with the likelihood of returning to sport. Younger athletes and competitive, male athletes appeared more likely to return. Across these studies, the 141 athletes not returning to pre-injury sport were questioned as to the reason for non return. An average of 35% (49 athletes) cited fear of re-injury as the reason. Fear of re-injury was thus investigated further as it could be considered in the post-operative management of anterior cruciate ligament reconstruction. In a qualitative study with supplemental cross-sectional analysis, factors informing fear of re-injury were explored. Male and female athletes, aged 17-50 years were included (n=59). Reconstruction procedures using any graft type were included; however revision and multi-ligament reconstruction was excluded. Twenty-four participants (41%) did not return to the pre-injury sport. Those citing fear of re-injury as the only reason for not-retuning to sport were interviewed (n=12). Thus, those who did not return to pre-injury type and level of sport despite good knee function. Athletes’ experiences informing fear of re-injury were explored by semi-structured interviews. Data analysis was performed by content analysis. Codes were allocated and categorised and these categories were synthesised into themes. The Qualitative review guidelines – RATS were followed. From the participant interviews, four themes emerged: undergoing the surgery and recovery again, nature of the pre-injury sport imposing risk of re-injury, personality traits, and social priorities. An accelerated rehabilitation programme was suggested to improve the post–operative experience. The supplementary analysis revealed athletes younger than 20 years of age were more likely to return to sport. Modifiable fears include pain, length of rehabilitation, mechanism of injury and psychological aspects. Pain management, motivation and education are important considerations post-operatively and during rehabilitation. Clinicians should be aware of factors informing fear of re-injury on an individual basis to develop a tailored management plan.

AFRIKAANSE OPSOMMING: OPSOMMING Die anterior kruisligament is die mees algemeen beseerde ligamente in die knie, met slegs een derde van die atlete wat terugkeer na hul pre-besering vlak van sport. Identifisering van intrinsieke faktore wat verband hou met 'n verhoogde moontlikheid van terugkeer na sport kan die chirurgiese uitkoms verbeter. 'n Sistematiese oorsig wat die Voorkeur Verslag Items vir Sistematiese oorsig en Meta-ontledingsriglyne volg, is uitgevoer . Die doel was om stelselmatig publikasies, wat intrinsieke faktore beskryf wat verband hou met terugkeer na sport na anterior kruisligament rekonstruksie, te beoordeel. 'n Omvattende kontrolelys is saamgestel. Metodologiese kwaliteit beoordeling van ‘n groep studies het 'n hoë gehalte studie aan die lig gebring, wat ingesluit is in die oorsig. 'n Beskrywende sintese van die bevindinge wat intrinsieke faktore met die terugkeer na sport assosieer, is uitgevoer. Tien studies is ingesluit. Die belangrikste bevinding wat terugkeer na sportdeelname verhinder was die vrees van herbesering. Kniefunksie het nie altyd ooreengestem met die moontlikheid van terugkeer na sport nie. Jonger atlete en wedywerende manlike atlete was meer geneig om terug te keer. In al die ingesluite studies, is die 141 atlete wat nie teruggekeer het na sport voorbesering ondervra oor die rede vir nie terugkeer. 'n Gemiddeld van 35% (49 atlete) het vrees vir herbesering as rede aangevoer. Vrees vir herbesering is dus verder ondersoek, as oorwegende faktor in die post-operatiewe bestuur van anterior kruisligament rekonstruksie. In 'n primêre, kwalitatiewe studie met aanvullende deursnee-analise, is die redes vir die vrees vir herbesering ondersoek. Manlike en vroulike atlete, tussen die ouderdomme van 17-50 jaar is ingesluit (n = 59). Rekonstruksie prosedures deur enige soort oorplanting is ingesluit; hersiening en verskeie ligament rekonstruksie is egter uitgesluit. Vier-en-twintig deelnemers (41%) het nie teruggekeer na die pre-besering sport nie. Diegene wat vrees vir herbesering as die enigste rede vir nie terugkering na sport aanvoer, is onderhoude mee gevoer (n = 12). Dus, diegene wat nie teruggekeer het na pre-besering, tipe en vlak, van sport ten spyte van goeie knie funksie. Die redes vir die vrees vir herbesering is ondersoek deur semi-gestruktureerde onderhoude. Dataanalise is uitgevoer deur die inhoud / tematiese analise. Kodes is toegeken en gekategoreer. Hierdie kategorieë is herverdeel in temas. Uit die deelnemer onderhoude, het vier temas na vore gekom: die operasie en herstel proses, die aard van die prebesering sport as risiko vir herbesering, persoonlikheidseienskappe en sosiale prioriteite. 'n Versnelde rehabilitasieprogram is voorgestel om die post-operatiewe ervaring te verbeter. Die aanvullende analise het getoon dat atlete jonger as 20 jaar oud meer geneig was om terug te keer na die sport. Aanpasbare oorsake van vrees sluit in pyn, die lengte van rehabilitasie, meganisme van besering en sielkundige aspekte. Pyn bestuur, motivering en opvoeding is belangrike oorwegings post-operatief en tydens rehabilitasie. Dokters en fisioterapeute moet bewus wees van die vrees vir herbesering en die veranderbare oorsake daarvan ondersoek op 'n individuele basis om 'n pasient spesifieke bestuursplan te ontwikkel.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/96773
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