Unfolding the complexity of anterior cruciate ligament injury through systems thinking methods (PhD Academy Award)

Abstract

My thesis aimed to investigate the aetiology of anterior cruciate ligament (ACL) injury, propose preventive measures and offer implications for ACL injury prevention and rehabilitation programmes by integrating innovative systems thinking methods. ACL injury is a complex phenomenon wherein various risk factors interact dynamically, thereby influencing the likelihood of injury in athletes.1 2 In light of this, it is essential to investigate the interrelationships among the risk factors to develop effective injury prevention strategies. Furthermore, screening tests that can be easily administered in field settings multiple times throughout the season, without compromising the validity and reliability of the data obtained, are necessary to identify possible negative adaptations in athletes. My doctoral research was structured into two primary phases. The initial phase involved a qualitative study that aimed to develop a Causal Loop Diagram (CLD) model and elucidate the aetiology of ACL injuries. The formulation of the ACL-CLD was achieved through the application of systems thinking techniques, specifically group model building. This process integrated a comprehensive literature review on ACL risk factors with structured scripts designed to engage stakeholders and incorporate their feedback.3 The second phase employed a quantitative approach to assess the relationships …