Return-to-Play in Sport: A Decision-based Model

Abstract

Our model helps clarify the processes that clinicians use consciously and subconsciously when making RTP decisions. Providing such a structure should decrease controversy, assist physicians, and identify important gaps in practice areas where research evidence is lacking.

At return to play following hamstring injury the majority of professional football players have residual isokinetic deficits

“…5 As long there remains a lack of quantifiable, valid and reliable determinants for RTS, there will persist a tension between early RTSs ( primary outcome in most trials) and risk of recurrence (predominantly used as secondary outcome).…”

“…In keeping with the decision-based RTS model, the physician's final decision was guided, but not determined by these medical factors, but included consideration of sport risk modifiers (step 2) and decision modifiers (step 3). 5 Accordingly, the isokinetic test was only one element of a comprehensive RTS process. If during the Sport Physician's assessment, any factor was established that did not allow the player to return to full participation, rehabilitation was resumed and reassessment performed prior to ultimate RTS.…”

The Challenge of Return-To-Play Decision after Anterior Cruciate Ligament Reconstruction

“…For example, a model developed by Creighton could clarify the processes that clinicians have to apply when making their decisions [7].…”

Biomechanical Adaptations After Fatiguing Exercise in Healthy and ACL Reconstructed Individuals

“…79,80 Therefore, return to play decision-making should include a number of other factors other than just patient-reported outcomes and laboratory measures of functional outcomes. 42 These measures should include sport-specific outcomes 82 as well as appreciation for sport risk modifiers and decision modifiers ( Figure B5). The missing variable that is not currently accounted for in decision models for return-to-play is biomechanical and muscular adaptations after exercise.…”

“…26 High level athletes have increased strength compared to recreational athletes, 31,64 and may require different sport-specific demands to evaluate fatigue-related biomechanical adaptations that may increase risk for injury in more fit athletes. 42,43 Therefore, the purpose of this study was to compare changes in running gait before and after generic exercise and sport-specific exercise between different fitness levels.…”