Public Perception of Anterior Cruciate Ligament Injuries and their Treatment


      Given the public has a poor understanding of ACL injuries and their treatment, patient education should focus on areas of knowledge deficit.

      Abstract Data


      There are over 200,000 anterior cruciate ligament (ACL) reconstructions performed yearly in the U.S. However, relatively little is known about the public’s perception of ACL injuries and their treatment. These perceptions are important for patient expectations and should guide physician-patient discussions. The primary objective of the current study is to test the hypothesis that the public’s perception of ACL surgery may be incorrect with regard to various aspects of this procedure.


      IRB approval was obtained for a 42-question survey designed to measure an individual’s knowledge base and perception of ACL reconstruction with regard to the anatomy, function, indications, operative technique, risks, recovery time, and overall benefits of the procedure. Twenty-nine questions were fact-based designed to have a correct answer. Demographic data regarding age, gender, ethnicity, educational level, employment, activity level, and surgical history were also obtained. Eligible individuals were between 15 and 60 years of age with no history of previous ACL injury. Individuals were recruited from an academic orthopedic sports medicine clinic, a collegiate athletic training room, and various public venues.


      A total of 210 individuals were surveyed (106 males and 104 females) with a mean age of 30 years (range, 15-56). Fifty-one percent of the factual questions were answered correctly. There was no relationship between the percentage of correct answers and gender, educational level, or employment in a health care setting. There was a positive correlation between activity level and the number of correct answers (p<0.0001), but a negative correlation between age and the number correct (p=0.003). Sixty-five percent of the respondents rated their ACL knowledge level as ‘little’ or ‘none’. Overall understanding of ACL anatomy and function was fair. Thirty-three percent of the respondents believed that a patient with a torn ACL requires surgery to walk; whereas, 51% believed the ACL is needed for cutting and pivoting activities. Thirty-two percent thought that ACL surgery involved sewing the torn ligament together and 70% thought that the risk of a re-tear was 25%-50%. Twenty-one percent expected that patients could return to all sports within 3 months from surgery and 50% believed that sports could be resumed after 6 months. Sixty-two percent believed that the success rate following ACL surgery was <75%. The ability to return to sports was the most important concern following ACL surgery followed by the risk of developing arthritis.


      This is the first study, to our knowledge, to assess the public’s perception of ACL injuries and their treatment. In general, there is wide variability in the lay public’s knowledge level of this condition with a significant number of misguided perceptions identified. Return to sports and risk for future osteoarthritis appear to be important factors to the lay public following ACL injury. Focusing educational efforts on areas of knowledge deficits may be particularly important to physicians treating patients with ACL injuries.