• Michael Makdissi, Paul McCrory, Antony Ugoni, David Darby, and Peter Brukner.
• Centre for Health, Exercise, and Sports Medicine, University of Melbourne, Parkville, Victoria, Australia 3010. makdissi@unimelb.edu.au
• Am J Sports Med. 2009 May 1; 37 (5): 877-83.

BackgroundDecisions regarding safe return to play after concussion in sport remain difficult.ObjectiveTo determine whether a concussed player returned to play using an individual clinical management strategy is at risk of impaired performance or increased risk of injury or concussion.Study DesignCohort study; Level of evidence, 3.MethodsAll elite Australian football players were followed for 4 seasons. Players were recruited into the study after sustaining a concussive injury. Outcome measures included performance statistics (disposals per hour match-time), injury rates, and recurrence of concussion on return to play. A subset of players had brief screening cognitive tests performed at baseline and after their concussion. Noninjured players matched for team, position, age, and size were chosen as controls.ResultsA total of 199 concussive injuries were observed in 158 players. Sixty-one concussive injuries were excluded from analysis because of incomplete data (45 players) or presence of concurrent injury (16 players). Of the 138 concussive injuries assessed, 127 players returned to play without missing a game (92%). The remainder of concussed players returned to play after missing a single game (8%). Overall, there was no significant decline in disposal rates in concussed players on return to competition. Furthermore, there were no significant differences in injury rates between concussed and team, position, and game-matched controls. In the subset of players who had completed screening cognitive tests, all had returned to their individual baseline performance before being returned to play.ConclusionReturn to play decisions based on individual clinical assessment of recovery allows safe and appropriate return to sport following a concussive injury.

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