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QUESTIONS: How do people with knee symptoms describe their quality of life and experiences 5 to 20 years after anterior cruciate ligament reconstruction (ACLR)? What factors impact upon the quality of life of these people? DESIGN: Qualitative study. PARTICIPANTS: Seventeen people with knee symptoms 5 to 20 years after ACLR and high (n=8) or low (n=9) quality of life scores were recruited from a cross-sectional study. METHODS: Semi-structured telephone interviews were conducted and transcribed. The data obtained from the interventions underwent inductive coding and thematic analysis. RESULTS: Four consistent themes emerged from the interviews as common determinants of quality of life following ACLR: physical activity preferences; lifestyle modifications; adaptation and acceptance; and fear of re-injury. All participants described the importance of maintaining a physically active lifestyle and the relationship between physical activity and quality of life. Participants who avoided sport or activity reported experiencing reduced quality of life. Participants who suppressed or overcame re-injury fears to continue sport participation described experiencing a satisfactory quality of life while taking part in sport despite knee symptoms. For some participants, resuming competitive sport resulted in subsequent knee trauma, anterior cruciate ligament re-rupture or progressive deterioration of knee function, with negative impacts on quality of life following sport cessation. Participants who enjoyed recreational exercise often adapted their lifestyle early after ACLR, while others described adapting their lifestyle at a later stage to accommodate knee impairments; this was associated with feelings of acceptance and satisfaction, irrespective of knee symptoms. CONCLUSION: Activity preferences, lifestyle modifications and fear of re-injury influenced quality of life in people with knee symptoms up to 20 years following ACLR. People with a preference for competitive sport who do not enjoy recreational exercise might be at heightened risk of poor quality of life outcomes and could benefit from support to facilitate a transition to a physically active, satisfying lifestyle.

Original publication




Journal article


J physiother

Publication Date





103 - 110


Fear of re-injury, Knee injuries, Osteoarthritis, Psychological adaptation, Return to sport, Adult, Anterior Cruciate Ligament Reconstruction, Cross-Sectional Studies, Exercise, Fear, Female, Humans, Knee Injuries, Knee Joint, Life Style, Male, Middle Aged, Qualitative Research, Quality of Life, Recreation