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Return-to-Play Criteria: The Delaware Experience

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Return to Play in Football

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Abstract

Most rehabilitation protocols and return-to-play (RTP) decisions are time-based rather than criterion-based. For over two decades, clinician-scientists at the University of Delaware have been implementing and advocating for the use of objective criteria to guide rehabilitation progression and RTP decision-making after anterior cruciate ligament (ACL) rupture and other knee injuries. Recent, high-quality research both from our cohorts and elsewhere supports and validates our approach. We have used the same objective clinical, functional, patient-reported, and time-based criteria to determine appropriate rehabilitation progression and RTP clearance for more than 20 years. Key clinical measures include achieving and maintaining full and symmetrical range of motion, minimal to no effusion, and no joint soreness. Functional testing consists of quadriceps strength and single-leg hop testing (single, crossover, triple, and 6 m timed hop tests); we compare the involved to uninvolved limb values to calculate limb symmetry indexes (LSI) with scores of 90% or greater representing symmetrical performance. Patient-reported outcomes, including the Knee Outcome Survey-Activities of Daily Living Subscale (KOS-ADLS) and Global Rating Scale of Perceived Function (GRS), assess patients’ self-evaluation of their knee function. Finally, we advocate for more delayed RTP time frames given the substantially increased risk of reinjury among athletes who return to high-level sports, such as football, prior to 9 months after primary ACL reconstruction. Our validated, objective RTP criteria include clinical impairment resolution and maintenance, ≥90% LSI for quadriceps strength and all four single-leg hop tests, ≥90% scores on the KOS-ADLS and GRS, and appropriate healing time (i.e., ≥9 months after primary ACL reconstruction). Athletes may then initiate a gradual RTP progression: individual drills, unopposed team drills, opposed individual and team drills, full practice, and finally competition. Using the Delaware RTP criteria may improve outcomes and lower reinjury risk.

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Authors and Affiliations

  1. Biomechanics and Movement Science, University of Delaware, Newark, DE, USA

    Jacob J. Capin & Lynn Snyder-Mackler

  2. Department of Physical Therapy, University of Delaware, Newark, DE, USA

    Lynn Snyder-Mackler

Authors
  1. Jacob J. Capin
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  2. Lynn Snyder-Mackler
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Correspondence to Jacob J. Capin .

Editor information

Editors and Affiliations

  1. UPMC Rooney Sports Complex, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Volker Musahl

  2. Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson

  3. Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany

    Werner Krutsch

  4. Santa Monica, California, USA

    Bert R. Mandelbaum

  5. Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal

    João Espregueira-Mendes

  6. Orthopaedic Surgery, Aspetar Hospital, Doha, Qatar

    Pieter d'Hooghe

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Capin, J.J., Snyder-Mackler, L. (2018). Return-to-Play Criteria: The Delaware Experience. In: Musahl, V., Karlsson, J., Krutsch, W., Mandelbaum, B., Espregueira-Mendes, J., d'Hooghe, P. (eds) Return to Play in Football. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55713-6_10

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  • DOI: https://doi.org/10.1007/978-3-662-55713-6_10

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