Perceptions, expectations and experiences of recovery before and after anterior cruciate ligament reconstruction: the patient voice – a protocol for a qualitative systematic review with meta-aggregation

Introduction: Anterior cruciate ligament (ACL) injuries are a common yet significant musculoskeletal problem and are increasingly prevalent outside of elite athlete populations. As a result, individuals may undergo ACL reconstruction (ACLR), but long-term complications frequently persist. Individuals commonly believe that post-ACLR, they will eventually return to preinjury levels of function. However, for multiple reasons, the reality is that more than half fail to reach this preinjury level. Rehabilitation has traditionally focused on physical factors, which have been researched extensively. More recently, psychological factors affecting recovery have been examined. However, most literature focuses on ‘outcome’, with the patient voice, in terms of their views and perceptions of ACLR neglected. Therefore, the aim of this systematic review is to understand individuals’ perceptions, expectations and experiences pre-ACLR and post-ACLR and to understand key factors influencing this journey. Such knowledge would assist in maximising the chances of successful recovery.

Methods and analysis: This meta-aggregative systematic review protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Medline, CINAHL, EMBASE and SportDiscus databases, grey literature and key journals will be searched from inception. Qualitative research of any study design that includes individuals aged 16+ years who are awaiting or have undergone ACL reconstruction will be included. Studies focusing on ACL revision, ACL repair or multiligament reconstruction surgeries will be excluded. Two independent reviewers will conduct searches, determine study eligibility, extract data, assess methodological quality (Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research) and rate the overall confidence in findings (JBI ConQual).

Ethics and dissemination: Findings will be published in a peer-reviewed journal, as well as presented at conferences and locally to physiotherapy teams. Ethical approval is not required for this systematic review.

PROSPERO registration number: CRD42024594621.