An array of factors goes into evaluation and ultimate decision on timetable

For any athlete who's ever gotten injured or for anyone who's encountered this type of predicament, it's a well-known fact that the chief question on the injured person's mind is nearly always: "How long before I can get back to playing again?" Athletes are often eager to get back on the playing field as soon as possible, and they view an injury mainly as an obstacle between them and that return. Due to the gravity and importance of this question, determining a timeframe that returns an athlete to sports quickly but ensures they're actually ready to start participating again is a complex process with multiple variables. It's usually agreed that this decision should be based on an athlete's health status, type and level of sport, and evidence-based risk factors, while others stress the importance of taking into account the sport's season, internal and external pressure to participate and conflict of interest. While there is some universality to the process, there can also be a great deal of variation, as many medical journals give statistics on a successful or safe return to sports without giving a clear definition on what "successful" or "safe" exactly means. To better categorize current guidelines and suggested approaches, and to point out gaps that need tending to, two physicians highlighted some important findings and offered their take on the matter.

Injury severity and level of sport both need to be considered

Two of the more important factors that need to be weighed into medical evaluations are the severity of the injury and the level of sport that the athlete is performing on. While it's understood and expected that a more severe injury will require more time to heal and a longer recovery than a minor one, it can at times be difficult to decide just how severe an injury is. Some simply use the number of days displaced from a sport to determine severity, but since criteria is needed in the first place to deem a player ready to return, that definition has its limitations. This calls for the necessity of creating a chart or scale of some sort with most of the common injuries out there and an accompanying level of severity to help better guide this process. Regarding the other factors mentioned, careful attention must be given to the level of sport, type of sport (pivoting vs. non-pivoting), and competitive vs. recreational sporting activities when making return-to-sports calls. Greater demands are usually imposed on the injured athlete if they participate at a high level and in a competitive organization, and pivoting sports are usually more prone to injuries than non-pivoting sports.

Evaluating the athlete and their readiness to return

When it comes to evaluating an athlete's abilities following an injury to see how prepared they are to return, measurements for muscle strength and range of motion, as well as different functional performance tests are usually used. While most of these tests are reliable, some may require adjustments to give then more accurate readings that correspond properly with other tests. For athletes who injure their anterior cruciate ligament (ACL), the ability to hop on the injured leg (hop performance) is considered one of the leading traits to show their ready to get back to sports. These tests have been proven extremely effective and should continue to be used for these types of injuries. One helpful guideline the European Board of Sports Rehabilitation recommends for athletes injuring their leg is as follows: using a limb symmetry index (LSI) to measure strength, for pivoting, contact and competitive sports, the injured leg should be 100% or greater than the non-injured leg in terms of both knee extension and knee flexing strength, and more than 90% for hop tests. For non-pivoting, non-contact and recreational sports, 90% or greater is recommended for all tests mentioned previously.

Moving forward

In the future, better criteria with clearer definitions on safe a successful returns to sports are needed, as are more evidence-based studies to determine these important timetables. More valid evaluation instruments tailored for different sports and injuries could greatly help this process as well. Most importantly, it must be understood that every athlete and injury is different, and they must be evaluated individually, but with the help of various tests and self-reported outcome measures, this task can be handled much more smoothly and help the athlete return as quickly and safely as possible.

-As reported in the Sept. 11 edition of Knee Surgery, Sports Traumatology, Arthroscopy