Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
, 10, 100

Choosing Surgery: Patients' Preferences Within a Trial of Treatments for Anterior Cruciate Ligament Injury. A Qualitative Study

Randomized Controlled Trial

Choosing Surgery: Patients' Preferences Within a Trial of Treatments for Anterior Cruciate Ligament Injury. A Qualitative Study

Carina A Thorstensson et al. BMC Musculoskelet Disord.


Background: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over').

Methods: Thirty-four in-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach.

Results: Strong preference for surgery was commonplace and many patients said that they joined the RCT in order to bypass waiting lists. Patients who chose to cross-over described training as time consuming, boring and as unable to provide sufficient results within a reasonable timeframe. Some said their injured knees had given-way; others experienced new knee traumas; and many described their lack of trust in their knee. Patients believed that surgery would provide joint stability. Despite the ostensible satisfaction with surgery, more detailed exploration showed mixed views.

Conclusion: Participants in a trial of treatments for acute ACL injury express a variety of views and beliefs about those treatments, and trial participation happens in the absence of equipoise. Furthermore, opting for surgical reconstruction does not necessarily provide patients with satisfactory outcomes. Definition of successful outcome may require an individualised approach, incorporating patients' as well as surgeons' views before treatment decisions are made.


Figure 1
Figure 1
Flowchart of recruitment to qualitative interviews.

Similar articles

See all similar articles

Cited by 11 articles

See all "Cited by" articles


    1. Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;10:1756–69. doi: 10.1177/0363546507307396. - DOI - PubMed
    1. Englund M, Roos EM, Lohmander LS. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum. 2003;10:2178–87. doi: 10.1002/art.11088. - DOI - PubMed
    1. Roos EM. Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol. 2005;10:195–200. doi: 10.1097/01.bor.0000151406.64393.00. - DOI - PubMed
    1. Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage. 1995;10:261–7. doi: 10.1016/S1063-4584(05)80017-2. - DOI - PubMed
    1. Linko E, Harilainen A, Malmivaara A, Seitsalo S. Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults. Cochrane Database Syst Rev. 2005. p. CD001356. - PubMed

Publication types

MeSH terms

Associated data