Thesis (MScPhysio)--Stellenbosch University, 2015. / 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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/96773 |
| Date | 04 1900 |
| Creators | Ross, Cheryl Anne |
| Contributors | Louw, Quinette, Clifford, Amanda, Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Physiotherapy. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 129 pages |
| Rights | Stellenbosch University |
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