Patient-Centred Care in ACL Reconstruction and Meniscus Repair and Rehabilitation: A Chinese Case Study

Introduction

There is an inherent risk for anyone who plays competitive sport or engages in strenuous activity that at some juncture they may suffer an injury which will require surgery. This is a situation in which prevention is not always a viable substitute for cure. Beyond the immediate pain and distress that injuries can cause and the difficult decisions that may have to be made with regards to surgery, there is also a wide range of physical and psychological challenges that patients will face and have to overcome during their recoveries. One of the most common, yet feared, injuries needing surgery is a torn or ruptured anterior cruciate ligament (ACL). Given that the increased prevalence of ACL injuries was being described as an epidemic for female athletes over a decade ago due to anatomical, environmental, hormonal, and bio mechanical factors (Silvers, 2009), and is now becoming a weekly occurrence in elite men’s sports with increased intensity also being cited (Dean, 2023) it is clear that this is a medical area of interest, especially in the world of football. Indeed, ACL injuries led to many acclaimed international female football players missing the 2023 FIFA World Cup (Sealy, 2023), and this trend in sport is likely to continue for the foreseeable future. It is also ominous that teenagers are now 29 times more likely to need surgery for this injury than two decades ago (Hughes, 2023). Beyond the personal challenges and direct economic burden resulting from these injuries, as Ross et al. (2023) draw attention to in the case of the latter point, and Hewett et al. (2010) suggests costs in the region of $17000 USD to $25,000 USD per surgery and rehabilitation programme, there is also the indirect but associated costs to employers. For example, the Al Hilal player Neymar, who had only recently moved to the club for a fee of $98.6m, suffered just such an injury while representing Brazil in international football (Garcia, 2023). With return-to-play rates revealing that only 65% of players still play at an elite level 3 years after a rupture (Walden et al., 2016), and return to pre-injury performance levels closer to 55% (Gokeler et al. 2022), this and the other aforementioned points present a concerning picture for all.