Patient Perspectives on the Contributors to and Impact of Delayed ACL Injury Diagnosis: A Qualitative Study

Anterior cruciate ligament (ACL) injuries are associated with physical, psychological and social consequences, yet diagnosis is often delayed. Existing research has focused on clinical and organisational contributors to delayed diagnosis, with limited attention on patient lived experiences of the diagnostic process. This study aimed to explore patient perspectives on the contributors to and impact of delayed ACL injury diagnosis. A qualitative study was conducted, informed by a critical realist perspective, using semi-structured interviews with ten UK-based adults who experienced a diagnostic delay exceeding three months following ACL injury. Data were analysed using codebook thematic analysis. Three interrelated themes were generated: understanding and interpreting the injury experience; navigating healthcare pathways and professional interactions; and the impact of delay, recovery and life disruption. Participants described early uncertainty, symptom normalisation and attempts to self-manage the injury, often influenced by competing work, study or family commitments. Delayed diagnosis was shaped by fragmented healthcare pathways, inconsistent advice, repeated consultations without progression and perceived dismissal of patient concerns. MRI and specialist consultations were commonly viewed as pivotal moments that validated the injury and diagnosis. Delayed diagnosis had substantial consequences extending beyond physical symptoms, including disrupted sport participation, altered occupational and parenting roles, psychological distress, and a perceived loss of time and opportunity. Diagnostic delay following ACL injury appears to arise through the interaction of patient decision making, clinical encounters and healthcare system constraints. Improving timely diagnosis may therefore require person-centred approaches that strengthen public awareness, support clearer communication and improve continuity and access within healthcare pathways.