"I found much more joy than I ever did as a player"- a qualitative study of the emotional journey of shattered dreams and new horizons with an ACL re-rupture in young active men.

backgroundIpsilateral second anterior cruciate ligament (ACL) injuries, are more common in males compared to females. An ACL re-rupture can imply both physical and psychological consequences for patients, with reports of lower objective and subjective outcomes after a re-rupture compared with primary ACL injury. This study aimed to explore young men's experiences of their first ACL injury, reconstruction and subsequent ACL re-rupture.

methodsEighteen males (19-33 years old) were interviewed with semi-structured interviews, which were recorded, transcribed, and analysed with qualitative content analysis, based on the method described by Graneheim and Lundman. The method involves a systematic process where three authors were involved. The interview transcripts were red multiple times, meaning units were identified, and codes were generated. These codes were then grouped into sub-categories and further sorted into main categories. Results were presented as a positive or negative psychological response through the four domains (cognition, affect, behaviour, and outcome) used in the model by Weise-Bjornsdal´s: cognition, affect, behavior and outcome, i.e., "the model of psychological response".

resultsFifteen main categories and 34 sub-categories emerged the data, presented as 2 timelines between the "first ACL injury" to "ACL re-rupture" and from "ACL re-rupture" and onwards. Positive emotions with the first ACL injury were high motivation to return to sport (RTS), great trust in the process of recovery and great support system from friends and family. Negatively, patients expressed shattered sport dreams, physical and mental trauma leading to experiences of identity loss, and a sense of loneliness. Positive experiences with the ACL re-rupture were humbleness and joy for other shapes of sport participation, such as coaching, and for activity to be joyful rather than performance connected. Negatively, patients searched for answers, e.g., whether surgery and rehabilitation were performed appropriately the first time, or whether the outcome could have been different with another autograft or if RTS was delayed.

conclusionAfter the first ACL injury, patients predominantly faced negative emotions that questioned their self-image. Despite several challenges, motivation remained high as the goal was RTS. Upon the ACL re-rupture, patients experienced a shift in perspective with sport participation and a door opening to new opportunities in life e.g., coaching. This unexpected turn of events became a catalyst for exploration of different aspects of emotions with the ACL journey, which included broader horizons beyond confines of athleticism. CLINICAL TRIAL NUMBER: Not applicable.