I am not going to sit here and tell you if a PT or a Surgeon is better.
Matter of fact, I will not say one or the other should be the one to clear you to return to sports after ACL reconstruction. However, in the past, surgeons have primarily had the responsibility to clear you to return to sports following an ACL injury.
If you read our previous post, you can tell that PTs have a tremendous amount of knowledge when it comes to ACL tears.
The purpose of this section is to illustrate the importance of teamwork in making the decision for an athlete to return to sport after an ACL reconstruction.
PTs and surgeons both bring something to the table and below are some examples how they both contribute to the decision to clear you to return to sports.
How your surgeon contributes to clear you to return to sports
Knowledge of the surgical process
PTs don’t have as much time to keep up to date on the research coming out on innovative surgical techniques.
For example, new surgical techniques for ACL tears have came to light in recent years, such as the anterolateral ligament reconstruction, or ALL [1].
Access to imaging
Although it would likely be noticed well before the time to clear you to return to sports, the ACL graft may not have healed properly.
Your surgeon has the access to give you an MRI (if needed) to ensure proper healing.
Furthermore, it is common for other tissues to get damaged with an ACL tear, such as ligaments or menisci. Imaging can also be helpful to ensure proper healing in more complex injuries.
Return to sport testing
The surgeon who performs your ACL reconstruction may have you sit on the table to assess strength and the laxity of your knee (aka how loose your knee is).
In most cases, that is all they are able to do, as they usually only have 10-15 minutes to spend with you.
I am not saying that they don’t think other tests are important, they just know that the PT will be performing the tests. Also, they likely don’t have the space or equipment available to complete a running or jumping assessment.
How your Physical Therapist contributes to clear you to return to sports
Psychological assessments
As mentioned in an earlier post, fear is a bigger concern for athletes when returning to sport than actual issues with their ACL tear.
Your surgeon may see you 2-3x throughout the whole rehab process.
On the other hand, your PT likely sees you on a weekly basis and is constantly re-evaluating your confidence to ensure you are progressing appropriately.
Look at the hypothetical example below that further illustrates who will likely be able to assess your confidence.
Time spent with surgeon
3-5 visits x 15-30 minutes/visit = 45-150 TOTAL MINUTES SPENT WITH SURGEON
Time spent with PT
30-40 visits x 30-60 minutes/visit = 900-2,400 TOTAL MINUTES SPENT WITH PT
I will let you decide who likely has a better understanding about your confidence when deciding to clear you to return to sports.
Return to sport testing
It’s unlikely your surgeon has the space to evaluate your running and jumping abilities.
And if they do, they are not constantly reassessing it like your PT is.
What if you have only been running and jumping normally for a week when you see your surgeon?
Do you think you should be getting back to playing?
Your PT is the one with you throughout the rehab process. Your PT is the one watching you run, jump, and cut on a weekly basis. At least, they should be.
So, who should I listen to?
To put it simply, it is up to you. Here are some thoughts that should be going through your head when you are in the sticky situation of not having clearance from both your PT and surgeon:
- Who do you trust more?
- Who do you think has the most knowledge on your current ability to play your sport?
- Has either one assessed your confidence in yourself prior to deciding to clear you to return to sports?
- If your surgeon clears you sooner and you agree with them, are you only agreeing with them so you can get back sooner?
- If your surgeon clears you sooner, how long did they spend with you to assess your knee stability, running performance, or jumping ability?
- If your PT has not cleared you, have they completed any of the return to sport tests to assess if you meet the criteria to return to sports?
- If your PT has decided to not clear you to return to sports, are they known for seeing patients an excessive amount in order to make more money?
Resources
- [1] Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI Study Group. Am J Sports Med. 2017;45(7):1547-1557. doi:10.1177/0363546516686057
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