The Silver Rule of Return To Sport Protocols

Clarity of expectations among surgical and rehabilitation providers is paramount following an extensive surgery like an ACL reconstruction. Post surgical protocols are one way to control or manage expectations. Generally, the point of contention between surgeons and physical therapists/athletic trainers is who decides what the protocol should look like. Physical therapists tend to reason that surgeons don’t have enough direct experience working with athletes outside the operating or examination room to dictate the patient’s progression. Conversely, the sentiment among many surgeons is that they effectively “own” the patient even after the surgery because they assumed the greatest risk and exercised the care that requires the most training and skill. An orthopedic surgery gone awry can result in permanent disability and even death. The worst case scenario rehab wise is a recurrence of the original injury (e.g. retearing the ACL during a change of direction scenario or disrupting a repair site via overly aggressive mobilization early on) in which case the surgeon would have to clean up the mess- again. Both parties’ concerns seem legitimate on the surface so what’s a reasonable compromise?

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