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Athletes might pay with quick return to play

In the world of sports, the ACL tear is a bogeyman, bringing seasons to sudden closes and requiring months of persistent rehab.

Understandably, young athletes don’t want to deal with a prolonged absence from competition, especially if they’re trying to make it to the next level. But returning to play too quickly may increase the risk of even more devastating injury and a serious decline in knee quality later in life.

Stephan Bodkin, Ph.D., assistant professor in the Department of Physical Therapy and Athletic Training, recently published an opinion piece in one of the field’s leading journals, Sports Medicine. In “Time to Reflect on Return to Sport Timing Following ACL Reconstruction” he presents recent literature suggesting that injured athletes who return to back to competition too quickly may be problematic.

“The common theme following ACL injury is that if you meet your functional goals early, you can return to sport early,” he said. “But my research and others have found that if you return to sport before suggested timeframes of 9-12 months, you’re at increased risk for re-injury. Even if someone looks great and strong, we should be cautious in returning them to sport at these accelerated time points.”

Originally return to sport (RTS) criteria for ACL injury and reconstruction focused primarily on time. However, within the last couple of decades sports medicine research has shifted to “criteria-based” protocols to evaluate rehabilitation progression which has ultimately promoted athletes returning to sport faster.

Bodkin cites a study of 106 patients returning to high-level sports to highlight the importance of time-based protocol. The athletes reduced their reinjury rate by 51% for every month they delayed their RTS. Another study of 159 patients found that athletes who returned before the 9-month time point were 6.7 times more likely to suffer another ACL injury.

“If you tear your ACL, you’re also at four times greater risk for knee osteoarthritis and three times more likely to have a total knee replacement in the future,” Bodkin said. “If you think about the long-term health of the athlete, that’s not ideal. If we can help manage short-term goals of when we return to sport which may reduce reinjury risk, we may also assist in preventing long-term health problems.”

Of course, patience is a tough virtue in the competitive, fast-paced world of sports. Bodkin works on the return-to-play committee with University of Utah Athletics and emphasizes the importance of managing expectations after injury.

“Healthcare providers should communicate return to sport goals and timelines with the athlete early and often to help manage expectations, so when they get to that time point they’re not as disappointed,” he said.

Part of Bodkin’s work involves working with athletic trainers and rehabilitation teams on what the latest data and research indicate. He knows there’s no guarantee of a safe return to sport if athletes return at later time points, but the whole team needs to carefully evaluate the need to play versus the need to heal.

“As rehabilitation specialists, we eventually reach a point where we are willing to take on a risk of reinjury for the reward of returning the athlete to the sport or activity they love doing. The risk of injury from sport will never be zero. As a healthcare team, it is our goal to guide athletes to this point while looking out for their current and future health and well-being.”