# “Returning to Sport Is Not Just About the Knee”: Physiotherapists’ Experiences of the Management of Anterior Cruciate Ligament Injury: A Qualitative Study

## TL;DR

This study explores how physiotherapists in Saudi Arabia manage ACL injuries, highlighting the need for holistic, culturally responsive rehabilitation approaches.

## Contribution

The study provides context-specific insights into ACL rehabilitation in Saudi Arabia, emphasizing the integration of psychological and cultural factors.

## Key findings

- ACL rehabilitation involves physical and psychological readiness influenced by cultural expectations.
- Disparities in resources and variability in protocols affect rehabilitation practices.
- Returning to sport requires more than passing tests, involving contextual and emotional factors.

## Abstract

Objectives: To explore sport physiotherapists’ perspectives and experiences on the management of anterior cruciate ligament (ACL) injuries in Saudi Arabia and to understand the key challenges that influence rehabilitation practice. Methods: A qualitative semi-structured interviews were conducted with sport physiotherapists recruited from different regions and clinical settings (Public, private and sport clubs) in Saudi Arabia. Eligibility criteria included ≥2 years’ post-qualification experience in ACL injuries management. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. A total of twenty-six sport physiotherapists (18 males; mean age 31 years, range 26–39) participated, including 13 working primarily as clinicians and 13 with combined clinical and research roles. Results: Five themes were identified: (1) disruptions of ACL injury in daily life and sport; (2) managing fear of re-injury and uncertainty in surgical vs. conservative care; (3) guiding rehabilitation through challenges of workload, progression, adherence and supportive tools; (4) variability in protocols, assessment tools, and available resources; and (5) returning to sport is more than just passing a test. These themes demonstrate that ACL injuries rehabilitation in Saudi Arabia is shaped by physical and psychological readiness, cultural expectations, and disparities in resources. Conclusions: Physiotherapists described ACL rehabilitation as a long-term process that needs an integration of physical, psychological, and contextual factors. This study’s findings highlight the need for resource-sensitive, standardized guidelines and the inclusion of psychological readiness assessments within rehabilitation processes. This study provides context-specific evidence that can be used to inform the development of culturally responsive, evidence-based approaches to strengthen ACL rehabilitation in Saudi Arabia.