Return to play – faster with surgery??

Schneller zurück zum Sport durch eine Operation – aus einem Vortrag von Prof. Erggelet vor den weltweit führenden Sportärzten/innen anlässlich des Isokinetic Kongresses in London in Zusammenarbeit mit der FiFA medical comission.
Can advanced surgical techniques enable an earlier return to play?
Does a modern surgical intervention provide a faster rehabilitation and return to sport than a non-operative treatment ?For the most common sport injuries there is no significant benefit for a surgical intervention regarding RETURN TO PLAY. (RTP) However, surgical procedures might be necessary to STAY IN PLAY (SIP) over the years.Tendons
Tendons do not heal and are usually under tension. Non-operative self healing will result in the formation of bridging scar tissue and of loss of function due to reduced stability of the tissue and lengthening of the tendon. Partial compensation is possible with muscle strengthening. Usually the non-operative approach allows for a faster RTP compared to surgical reconstruction at the price of a reduced SIP period due to failing compensation mechanisms when getting older.
An unstable knee after ACL Rupture will lead to an early career ending osteoarthritis without surgery. After surgical ACL reconstruction a RTP after 6-12 M are most common and enables SIP with a hight probability.
Modern surgical developments like double bundle reconstruction,  anatomic single bundle or graft choice/allograft treatment show no conclusive benefits for an earlier RTP. For stable knees a non operative treatment might allow for a RTP after 3-4 M. The same applies to MCL or LCL lesions
Advanced techniques for surgical reconstruction of e.g. acute lesions of the achilles tendon allow for early rehabilitation and loading, preventing muscle loss and stiffness of the ankle.Meniscus and Labrum
Like tendons this cartilaginous tissue only heals with scarring. When protected in a physiological position self healing without elongation or dislocation can occur. In that case, an early RTP is possible after regaining muscle strength and full ROM of the joint. If healing does NOT occur, a secondary reconstruction or partial resection becomes necessary with reduced chances of success. With more advanced techniques and instruments primary surgical interventions seem to be advisable to prevent pain and instability e.g. in knee, shoulder or hip. This will lead not necessarily to an earlier RTP but to a higher chance to SIP.Cartilage
For the repair of cartilage lesions surgical interventions, not even the most advanced ones, do NOT offer any benefit regarding RTP. Longterm outcome e.g. for autologous chondrocyte transplantation seem to indicate a higher chance of SIP.Fractures
Fractures need a certain time to heal, depending on the location/bone – with or without surgical intervention. But a surgical stabilization promotes faster rehabilitation, a decreased loss of joint function and in consequence a faster RTP. Advanced implants and operation techniques reduce the morbidity of a surgical intervention.Conclusion
To date surgical interventions cannot beat the natural healing process but the combination of advanced techniques and a progressive and well balanced rehabilitation will lead to an safer return to play and a higher chance to stay in play.