Eminence-based medicine versus evidence-based medicine: when can the athlete with a sprained ankle return to play?

When can the athlete with a sprained ankle to return to play? The medical literature provides no definitive answer to this question, so we surveyed 500 experts in sports medicine, and asked them if they agree with the following statement: "For patients with an acute ankle injury, the ability to hop on the sidelines is sufficient evidence to allow the athlete to return to the field." Overall, the experts did not endorse this statement. Further, a review of the medical literature failed to lend support for the statement. Taken together, some level V (expert opinion) evidence emerges, namely, that a patient's ability to successfully complete the hop test is not necessarily sufficient evidence to allow a return to play. That finding does not mean that a physician must shun the test; rather, the conclusion is that it cannot be relied on in isolation. The hop test, used in context with other findings, along with a consideration of the risks and benefits of continued play, may help the physician on the field reach a reasonable conclusion. To date, however, there is no single, easily applied test that can correctly determine whether an athlete is safe to return to the field.