Why did my surgeon clear me for return to sport, but my PT hasn’t?

This is a question we often get at Mobility Fit Physical Therapy. A client has gone through several months of rehab and is feeling great so the surgeon says they are safe to return to their sport. However, when that same client asks the physical therapist, he or she tells the client that they do not recommend going back to their sport yet.

Why the difference in opinions? Who is correct?

The short answer…BOTH!

A surgeon and a physical therapist both look at different things when telling an athlete whether they should or should not return to their sport.

When considering return to sports, a surgeon will typically be referring to the strength of the repair. For example, in an ACL repair the surgeon would be referring to the tensile strength of that new ligament. At 6 months, that ligament has undergone significant changes and has healed itself. Often, that ligament is now stronger than the ACL that person was born with. This is meant quite literally – if we tied both the repaired ligament from one knee and the uninjured ligament from the other knee to a heavy weight, the repaired ligament would take more force to rupture. This means that a surgeon telling a client their ACL is recovered at 6 months is completely correct.

However, when a physical therapist considers return to sport they are typically referring to deficits that a client still has in their movements, as well as what the published literature says about retear rates. In the vast majority of clients, the function on the repaired side has not yet matched the function on the uninjured side (or within 90%, which is the standard barometer used in ACL repair research). We know this from return to sport testing – single leg hop, triple hop, crossover hop, etc (all tests commonly used to make a return to sport decision). We also see in the case of an ACL repair the retear rates are much higher from 6-9 months than they are after 9 months. This means that a physical therapist telling that same client at 6 months that they are not ready for return to sport is completely correct.

So, what is a person recovering from ACL repair (or any other surgery) to do?

Actively participate in the recovery process by working as a team with your surgeon and physical therapist, asking questions as needed to achieve understanding.

The entire healthcare system is designed to work as a team. In the case of ACL repair that team consists mostly of the surgeon that performed the repair, the physical therapist leading the rehab, and of course, YOU! As the person who is in charge of that knee, you should be willing to ask questions – Am I cleared? Why or why not? What steps must I complete to be cleared? I promise not only are we at Mobility Fit happy to answer your questions, but we appreciate working with clients that take ownership of their rehab.

We hope this helped answer one of our common questions at Mobility Fit. Please feel free to reach out to us on social media on topics you’d like to see covered in future blogs!