RETURN TO PLAY AFTER SPORTS INJURY I Dr.RAJAT JANGIR JAIPUR #aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur #allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon To Know more about ACL Injury, Click the links below: 1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all" https://youtu.be/oWkIr8IXvr8 2. Everything about ACL Injury tear surgery in Hindi I https://youtu.be/bqpjkAkwZ14 3. Best Screw for ACL tear surgery in Hindi https://youtu.be/1LGpU1NHiIs 4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir https://youtu.be/SIAPWiMbOqs 5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ? https://youtu.be/NEJRPKskJTI 6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ? https://youtu.be/EXpgy19Jxzw 7. PRP injection therapy in Partial ACL TEARs https://youtu.be/qyG1EYgS87E Dr.RAJAT JANGIR(Asso Prof.) Senior Consultant Arthroscopy and Joint Replacement (Specialist in Shoulder Knee Hip Surgery) Ligament and Joints Clinic 67/34 Mansarovar Jaipur Whatsapp: shorturl.at/gnAEP Appointment: +91 8104855900 Email: ligamentsurgeon@gmail.com Google Page: https://g.page/KNEE-Shoulder-SURGERY?... Facebook: https://www.facebook.com/Ligamentandj... * Vast experience and specialisation in the field of Arthroscopy and sports surgery. * M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad * Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea * Diploma in Sports Medicine from InternationaI Olympic Committee * Invited as Athlete Medical Doctor at Rio Olympic 2016 * Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'

1. RETURN-TO-PLAYAFTER
SPORTS INJURY

2. Fellowship In Arthroscopy(South Korea)
International Olympic Committee Diploma Sports Medicine(UK)
Sports Physician RIO Olympic 2016
Dr.RAJAT JANGIR
Consultant Arthroscopy and Orthopedic Surgeon
Saket Hospital, Mansarovar
Assistant Professor
Mahatma Gandhi Medical College, Jaipur

3. INJURY DEFINITION
• Varies greatly by study causing inconsistencies in
reported data and study comparison difficult.
• Consensus statements
Football. Fuller, 2006
Fuller CW, Ekstrand J, Junge A, et al. Consensus statement
on injury definitions and data collection procedures in studies
of football
(soccer) injuries. Clinical journal of sport medicine : official
journal of the Canadian Academy of Sport Medicine
2006;16:97-106.
Rugby. Fuller, 2007
Fuller CW, Molloy MG, Bagate C, et al. Consensus statement on
injury definitions and data collection procedures for studies of injuries
in rugby union. British journal of sports medicine 2007;41:328-31.

4. INJURY CONSENSUS
Standardization of: – Injury definition– Injury
classification
• type, location, event – Injury location
• Specificity: anterior or posterior thigh, – Type of Injury
• new, recurrent, medical attention, non-fatal catastrophic, acute,
overuse, non-structural vs. structural, etc

5. INJURY CLASSIFICATION
• Most studies have only collected time loss injuries
• Recent development and validation of a new method for
the registration of overuse injuries
– Found 10 times as many overuse injuries than standard
injury registration methods.

6.  Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for
the registration of overuse injuries in sports injury epidemiology: the Oslo Sports
Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. British journal
of sports medicine 2013
 Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse
symptoms in sports. British journal of sports medicine 2009;43:966-72

7. OBJECTIVES
Multiple factors that may influence return to
play decisions
To outline the process by which physicians
may approach decision making
To introduce a 3-stage decision-based model
of RTP

8. 3 REASONS R-T-P IS DIFFICULT
No absolute contraindications to sports
participation
Pressure to use treatment approaches that are
not scientifically validated
Return-to-play decisions are usually made on
a case by case basis

10. WHY IS RTP IMPORTANT?
 Greatest risk for injury is past injury – return-to-play
decisions affect injury rates
 For team physicians, RTP is central to our work; it is
what we spend most of our time doing
 The treatment of individual cases (case-by-case) limits
our ability to understand populations and generalize
treatments

11. RETURN TO PLAY QUESTIONS
1. Would you allow a rugby player with a grade 2 AC
sprain to play with pain 1 week after injury?
2. Would you inject the AC joint with lidocaine if asked?
3. Would you inject it for 4 weeks in a row for a game?
4. Would you return a rugby player to same game if
asymptomatic after 1st concussion with no LOC?
5. Would you return a rugby player to same game if
asymptomatic after 1st concussion with LOC?
6. Would you return a rugby player to same game if
asymptomatic after 2nd concussion (3 mos.) no LOC?

12. RETURN TO PLAY QUESTIONS
7. Would you allow a rugby player with a grade 2 MCL
sprain to play 2 weeks after injury?
8. Would you make them wear a brace?
9. Would you let a female runner with a BMI of 16
compete despite no weight gain the past 3 weeks?
10. Would you let a soccer player with mono diagnosed
one week ago compete if asymptomatic & no
findings?
11. Would you allow a gymnast with a new pars stress
fracture to compete for the last 6 weeks of season?
12. Would you allow a female runner with 1.5 SD low
BMD & amenorrhea, BMI 18 to continue running?
13. Would you allow a soccer player with large single

13. IOC ADVANCED TEAM PHYSICIAN COURSE
MATHESON, 2008
1. Would you allow a rugby player with a grade 2 AC
sprain to play with pain 1 week after injury? 100%
2. Would you inject the AC joint with lidocaine if asked?
77%
3. Would you inject it for 4 weeks in a row for a game?
26%
4. Would you return a rugby player to same game if
asymptomatic after 1st concussion with no LOC?
74%
5. Would you return a rugby player to same game if
asymptomatic after 1st concussion with LOC? 13%
6. Would you return a rugby player to same game if
asymptomatic after 2nd concussion (3 mos.) no
LOC? 60%

14. IOC ADVANCED TEAM PHYSICIAN COURSE
MATHESON, 2008
7. Would you allow a rugby player with a grade 2 MCL sprain to
play 2 weeks after injury? 56%
8. Would you make them wear a brace? 46%
9. Would you let a female X-country runner with a BMI of 16
compete despite no weight gain the past 3 weeks? 74%
10. Would you let a soccer player with mono diagnosed one week
ago compete if asymptomatic & no findings? 53%
11. Would you allow a gymnast with a new pars stress fracture to
compete for the last 6 weeks of season? 23%
12. Would you allow a female runner with 1.5 SD low BMD &
amenorrhea, BMI 18 to continue running? 76%
13. Would you allow a soccer player with large single compartment
OC knee lesion to continue playing? 40%

15. IMPORTANCE OF SIGNS INFLUENCING
RTP
Practice Management of Musculoskeletal Injuries in Active Children
Boudier, Revéret et.al. ,BJSM, 2010

16. Who Can’t Play?
repeated concussion retirement no evidence+based guidelines
RTP after fever/acute infection? use cautious common sense
one kidney or testis? evidence remains limited
first time shoulder dislocation? not an easy question to answer
spondylolysis avoid extension activities
patellar tendinopathy conservative treatment
chronic groin pain there are no short cuts
corticosteroid injection shoulder no definitive effectiveness
plantar fasciitis rest, stretch, inject + all else is
controversial & unsupported

17. RTP DEFINITIONS
Allowed to practice
Partial return (no contact)
Medical clearance of an athlete for full
participation in sport without restriction
(strength and conditioning, practice, and
competition)

18. CLEARANCE V/S MONITORING
Clearance decisions require the assurance of
appropriate monitoring of identified problems
If “clearance” is dynamic, physicians must feel
comfortable with follow-up & participation
status

19. “If a team physician does not fully inform an
athlete of the potential dangers associated with
playing with a particular injury, or the risks of a
proposed treatment, the athlete’s decision is
uninformed.”
DiCello N. Exploiting Professional Athletes. 2001;49:507+538

20. THE MOST IMPORTANT FACTOR?
….....................is not a factor
It is an approach
Synthesizing evidence
Blended into a decision making
process

22. FROM EVIDENCE TO DECISION
MAKING
Extensive literature review
Categorized variables noted in the literature
Many factors mentioned, but poor evidence
regarding importance

24. DECISION MAKING:
THE INFLUENCE DIAGRAM
Representation:
 States of nature elements are circles
 Circumstances under which decisions are made
 Decision elements are squares
 Arrows are used to illustrate when information from
one element contributes information to another
element
Integrates and sequences factors, how
they interact and when they should be
considered in the clinical decision
process

25. YOUR ROLE?
Advisor / Advocate?
Paternalistic / Authoritarian?

26. BY WHAT STANDARD ARE YOU
JUDGED?
 Daily Environment= SPORT
 Coach
 Manager
 Agent
 Professional Environment= MEDICAL
 Colleagues
 Licensing bodies
 Malpractice Insurer

27. WHO’S IN CHARGE?
Who has the final say?
 Medical staff
 Official, coach, manager, administrator?
Who assumes final responsibility?
 “point person”
 liability

28. TAKE HOME MESSAGE
Many factors
Consider them in the right order
 Medical
 Participation Risk
 Decision Modification
Can be recursive
In sport medicine we look after the athlete
We should practice good medicine in sport,
and look after our patient, the athlete

30. Fellowship In Arthroscopy(South Korea)
International Olympic Committee Diploma Sports Medicine(UK)
Sports Physician RIO Olympic 2016
Dr.RAJAT JANGIR
Consultant Arthroscopy and Orthopedic Surgeon
Saket Hospital, Mansarovar
Assistant Professor
Mahatma Gandhi Medical College, Jaipur
Mobile- 8104855900
dr.rajatjangir@gmail.com