What influences the choice of treatment in patients with total anterior cruciate ligament rupture?

Background and aims: This study aimed to explore how selected attributes influence patients' preferences for operative and non-operative treatment of total anterior cruciate ligament (ACL) rupture.
Methods: This study was designed as a qualitative semi-structured interview study. Attributes were derived from existing literature and were used to create a choice set informing the interview guide. Thematic analysis was used.
Results: Interviews were conducted with eight respondents. Four men and four females [median: 23 y/o], who had either chosen operative or non-operative treatment, participated. The study uncovered seven themes that influenced the patients’ treatment preference; “Long term benefits”, “Identity”, “Patient beliefs”, “Willingness to take risks”, “Impact on my daily life”, “Pain”, and “Rehabilitation”. Across interviews, it was identified that the respondents linked their identity to physical activity. Therefore, the prospect of returning to physical activity influenced the patients’ treatment preferences. Additionally, patients had higher demands for the level of physical activity when choosing operative treatment. Furthermore, attributes such “as the risk of infection and blood clots”, “pain level”, and “temporary impact on daily life” during and after surgery influenced patients’ treatment choices to a lesser degree.
Conclusions: Returning to physical activity is highlighted as important, due to its link to the patient’s identity. Patients seemed less affected by pain, impact on daily life, and risk of surgery when choosing a treatment. Furthermore, the patients’ decision-making is influenced by their beliefs and the beliefs are influenced by the expectations of friends and family and by guidance from healthcare professionals.