Exploring the support environment for people following anterior cruciate ligament injury in Aotearoa New Zealand

Background Anterior Cruciate Ligament (ACL) injury and subsequent ACL reconstruction (ACLR) have a significant health impact in Aotearoa New Zealand (AoNZ). These injuries frequently lead to the development of post-traumatic osteoarthritis (PTOA) and can considerably disrupt the lives of typically young, active individuals, often requiring lengthy rehabilitation and effecting overall well-being. This study aimed to gain insights from health professionals and the communities caring for people with PTOA following ACL injury in the medium- to long-term in AoNZ to inform more effective and contextually appropriate approaches to management and well-being for this patient group. Method A qualitative Interpretive Description study was employed. Semi-structured individual interviews gained insights from end-users who could speak to the management of people with PTOA following ACL injury. Data were thematically analysed. Findings: 16 participant end-users including health professionals, sports coaches, whānau (family), and policy makers were interviewed. Four themes were developed from the data: 1) Knee for life: Supporting the whole journey (recognising the long-term consequences of PTOA that can be neglected in the health system), 2) Care beyond the clinic (community engagement and a collaborative effort is required to provide long-term holistic care), 3) The blame game (financial and hierarchical conflicts surround ACL and PTOA rehabilitation, where limited accident insurance funding, and a reluctance of external services to accept responsibility impede outcomes), and 4) Shifting the goal posts: Beyond athletes and sport (a prominence of sport and athlete models of care dominate ACL management, where care and successful outcomes should extend beyond the physical aspects and more closely reflect holistic measures and patients' personal goals). Conclusion and Impact: ACL injuries should be viewed as a lifelong evolving journey rather than self-limiting isolated events. Clinically, adopting a multidisciplinary, patient-centred approach is critical. Early and sustained patient education on long-term knee health, lifestyle adaptation, and involving whānau in rehabilitation are essential. Transitioning from an injury-focused model to a holistic, sustainable support approach can significantly enhance long-term outcomes after an ACL injury and development of PTOA. Future research should prioritise developing and evaluating integrated, context-specific care models specific to the AoNZ context.