Return to play guidelines after anterior cruciate ligament surgery

Doctors should question whether return to high level pivoting sports is in the athlete’s best interest after ACL reconstruction “When can I play again, Doc?” is the emotionally charged, quintessential question asked by nearly every athlete after anterior cruciate ligament (ACL) injury. Invariably, the same question is one of the first asked by parents, team mates, coaches, and—in the case of the high profile athlete—the media. This implies that, to meet the expectations of the athlete and his/her surroundings, swift surgical intervention and accelerated rehabilitation becomes a priority. Therefore it is not surprising if the time to return to play is the standard by which orthopaedic surgeons measure themselves and are measured in sports circles. Measured by this standard, sports medicine has made giant advances in ACL treatment programmes during the previous decades. We have progressed from open surgery to arthroscopic surgery, from extended casting to short term bracing, from conservative to accelerated rehabilitation programmes, and from long hospital stays to outpatient surgery. When an athlete is injured today, it is expected that arthroscopic surgery will take place a few weeks after injury, that rehabilitation is started immediately, and that the patient is able to return to sport in four to nine months. The “best” surgeons and physiotherapists are rumoured to return players even sooner. “Are there other criteria whereby we should measure treatment outcome than the time to return to sport?” Lost in the need to succeed and with the fear of defeat deeply embedded in our decision making processes, it is no wonder that we rarely ask: “Is it time to quit? Is it safe to return patients to pivoting sports? What are the long term results of our treatment programmes? Are there other criteria whereby we should measure treatment outcome than the time to return to sport?” …