title: Influence of left- and right-side total hip arthroplasty on the ability to perform an emergency stop while driving a car. Effects of upper-limb immobilisation on driving safety. Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes. Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study. The effect of shoulder immobilization on driving performance. When Is It Safe to Return to Driving After Spinal Surgery? Measurement of brake response time after right anterior cruciate ligament reconstruction. Driver Reaction Time Before and After Treatment for Lumbar Radiculopathy Driving reaction time before and after anterior cervical fusion for disc herniation: a preliminary study Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument Driving reaction time before and after surgery for disc herniation in patients with preoperative paresis. The effect of immobilization devices and left-foot adapter on brake-response time. Rapid Rehabilitation and Recovery with Minimally Invasive Total Hip Arthroplasty The effects of task complexity on brake response time before and after primary right total knee arthroplasty. Driver reaction times after total knee replacement. Return to Functional Hand Use and Work Following Open Carpal Tunnel Surgery Driving with an arm immobilized in a splint: a randomized higher-order crossover trial. Driving reaction time before and after surgery for lumbar disc herniation in patients with radiculopathy Early Discharge and Recovery with Three Minimally Invasive Total Hip Arthroplasty Approaches: A Preliminary Study Repair of acute rupture of the Achilles tendon: a new technique using polyester tape without external splintage. Brake response time after total knee arthroplasty: when is it safe for patients to drive? Effect of knee brace type on braking response time during automobile driving. Driving Reaction Time Before and After Primary Fusion of the Lumbar Spine When is it safe for patients to drive after right total hip arthroplasty?
abstract: OBJECTIVE To show the possible effect of  left- and right-side total hip arthroplasty ( THA )  on the ability to perform an emergency stop when driving a car . DESIGN Inception cohort . SETTING A driving simulator using an actual car cabin , specifically developed for the experiment , was used for testing driving ability . PARTICIPANTS Patients ( N=40 ; 20 left-side THA/20 right-side THA )  were tested preoperatively and in increments of 8 days and 6 , 12 , and 52 weeks after surgery . INTERVENTIONS Left- and right-side THA . MAIN OUTCOME MEASURES Reaction time , movement time , total brake response time ( TBRT ) , and maximum brake force . RESULTS Eight days postoperatively , measurements on driving performance indicated a slight worsening for all outcome parameters in patients after left-side THA and considerably more worsening in patients after right-side THA . For both patient groups , significant improvements in outcome measures were noted during the 1-year follow-up . Brake force declined significantly in patients with left-side THA ( P=.012 ) and in patients after right-side THA ( P<.001 ) . A total of 35 % of the patients with right-side THA and 15 % with left-side THA could not meet the 600 ms TBRT threshold 6 weeks postoperatively . CONCLUSIONS Most patients who underwent right-side THA reached their preoperative baseline 6 weeks after surgery . Most of the patients with left-side THA showed no TBRT limitations 8 days postoperatively . Because of the patients ' highly individual rehabilitation course and considering the possible consequences of the premature resumption of driving a motor vehicle , individual examination and recommendation are necessary Doctors are frequently asked by patients whether it is safe to drive with an upper limb immobilised in a cast . In the literature there are no objective measurements of the effects of upper-limb immobilisation upon driving performance .  Eight healthy volunteers performed four 20-min driving circuits in a driving simulator ( STISIM 400W ) , circuits 1 and 4 without immobilisation and circuits 2 and 3 with immobilisation . Immobilisation involved a lightweight below-elbow cast with the thumb left free . Volunteers were r and omised to right or left immobilisation for circuit 2 , and the contralateral wrist was immobilised for circuit 3 . Circuits included urban and rural environments and specific hazards ( pedestrians crossing , vehicles emerging from a concealed entrance , traffic lights changing suddenly , avoidance of an oncoming vehicle in the driver 's carriageway ) . Limb immobilisation led to more cautious rural and urban driving , with less adjustment of speed and lateral road position than when unrestricted . However when responding to hazards immobilisation caused less safe driving , with higher speeds , a greater proximity to the hazard before action was taken and less steering adjustment . The effects of restriction upon performance were more prevalent and severe with right-arm immobilisation . Upper-limb immobilisation appears to have little effect on the ability to drive a car unchallenged , but to adversely affect responses to routine hazards . Advice on ability to drive safely should be cautious , as the impact of immobilisation appears to be more subtle and wide ranging than previously thought PROBLEM To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator , and to determine which measures were associated with the occurrence of motor-vehicle crash . METHOD One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study . Using the driving simulator , appropriate driving tasks were devised to test the older drivers , whose performances were assessed by 10 reliable assessment criteria . Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome . RESULTS As expected , driving skill of older drivers was found to decline with age . Over 60 % of the sample participants reported having at least one motor-vehicle crash during the past year . Adjusting for age in a logistic regression analysis , the cognitive abilities associated with the crash occurrence were working memory , decision making under pressure of time , and confidence in driving at high speed . SUMMARY The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator . Prospect i ve studies need to be undertaken to determine whether the driving simulator can predict future crash events . IMPACT ON INDUSTRY This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered Patients undergoing total knee arthroplasty often ask when they can safely resume car driving . There is little evidence available on which physicians can rely when advising patients on this issue . In a prospect i ve study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery . On each measurement day the patients performed two tasks , a simple and a complex brake response time task in a car simulator . Ten days after left TKA the brake response time for the simple task had decreased by 3.6 % ( p=0.24 ) , the reaction time by 3.1 % ( p=0.34 ) and the movement time by 6.6 % ( p=0.07 ) . However , the performance improvement was not statistically significant . Task complexity increased brake response time at both time points . A 5.8 % increase was significant ( p=0.01 ) at 10 days after surgery . Based on our results , we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission BACKGROUND The purpose of this study was to evaluate the effect of sling immobilization on driving performance with use of a driving simulator . METHODS This is a prospect i ve trial with a cohort of 21 healthy volunteers comparing their driving ability with and without sling immobilization on their dominant ( driving ) extremity . Multiple variables , including number of collisions , off-road excursions , and centerline crossings , were measured with a vali date d driving simulator . Trials were separated by 2 weeks to control for " adaptations " to the simulator . Statistical significance was found in collisions between sling and no-sling tests . RESULTS The total number of collisions for trial 1 ( no sling ) was 36 ( mean , 1.7 ± 1.2 ) compared with 73 ( 3.7 ± 1.6 ) ( P < .01 ) for trial 2 ( sling immobilization ) . Approximately 70 % of participants with upper extremity immobilization were involved in ≥3 collisions ; approximately 70 % of no-sling participants were involved in ≤2 collisions . There was no statistically significant difference between groups with respect to overall vehicle road position and control . CONCLUSION Sling immobilization of the dominant driving arm results in a decrease in driving performance and safety with respect to the number of collisions in a simulated driving circuit ( P < .01 ) . There were no significant differences in driving parameters that are indicative of overall vehicle position and control . The decrease in driving performance with respect to the number of collisions is likely to be related to the effect the immobilized arm has on effectively performing evasive maneuvers during hazardous driving conditions Study Design Prospect i ve study . Objective Surgeons ’ recommendations for a safe return to driving following cervical and lumbar surgery vary and are based on empirical data . Driver reaction time ( DRT ) is an objective measure of the ability to drive safely . There are limited data about the effect of cervical and lumbar surgery on DRT . The purpose of our study was to use the DRT to determine when the patients undergoing a spinal surgery  may safely return to driving . Methods We tested 37 patients ’ DRT using computer software . Twenty-three patients ( mean 50.5 ± 17.7 years ) received lumbar surgery , and 14 patients had cervical surgery ( mean 56.7 ± 10.9 years ) . Patients were compared with 14 healthy male controls ( mean 32 ± 5.19 years ) . The patients having cervical surgery were subdivided into the anterior versus posterior approach and myelopathic versus nonmyelopathic groups . Patients having lumbar spinal surgery were subdivided by decompression versus fusion with or without decompression and single-level versus multilevel surgery . The patients were tested preoperatively and at 2 to 3 , 6 , and 12 weeks following the surgery . The use of opioids was noted . Results Overall , the patients having cervical and lumbar surgery showed no significant differences between pre- and postoperative DRT ( cervical p = 0.49 , lumbar p = 0.196 ) . Only the patients having single-level procedures had a significant improvement from a preoperative DRT of 0.951 seconds ( st and ard deviation 0.255 ) to 0.794 seconds ( st and ard deviation 0.152 ) at 2 to 3 weeks ( p = 0.012 ) . None of the other subgroups had a difference in the DRT . Conclusions Based on these findings , it may be acceptable to allow patients having a single-level lumbar fusion who are not taking opioids to return to driving as early as 2 weeks following the spinal surgery OBJECTIVE Recommendations on safe driving after  anterior cruciate ligament ( ACL ) reconstruction  have been largely intuitive . We studied brake response time in patients who participated in outpatient rehabilitation after right ACL reconstruction .  DESIGN Prospect i ve , repeated measures design comparing 14 patients post-ACL reconstruction with 21 subjects with normal knees . INTERVENTIONS AND MAIN OUTCOME MEASURES The following measures were assessed every 2 weeks for 10 weeks :  brake response time , 6-meter walk time , knee range of motion , pain , and joint effusion . Statistical testing used analysis of covariance with repeated measures . Significant variables were analyzed separately and post hoc tests conducted using the least squares differences method . Both groups were compared with published norms from the American Automobile Association . RESULTS No significant gender differences across main effects were detected . Brake response times for men improved significantly after week 6 ( p < .05 ) and week 10 ( p < .01 ) . Brake response times for women in the ACL treatment group matched controls at 6 weeks . Six-meter walk times for control subjects were faster than those for the ACL group preoperatively ( 2.6 sec vs 5.5 sec ) , but equalized by week 6 . CONCLUSIONS After right ACL reconstruction , brake reaction times of rehabilitated men and women matched those of established controls after 4 to 6 weeks . Measuring brake response times during rehabilitation may ensure that individual patients return to driving in a safe and timely manner Study Design . Prospect i ve observational pilot study . Objective . To investigate the effect of  right and left radiculopathy on  driver reaction time ( DRT ) , and the effect of selective nerve root block ( SNRB ) on DRT . Summary of Background Data . The effect of many orthopedic procedures on DRT has already been assessed . To date the effect of radiculopathy and SNRB on DRT has not been studied . Methods .  DRTs  of 20 radiculopathic patients ( 10 right , 10 left ) were measured using a custom-built car simulator . Each patient was tested pre-SNRB , immediately post-SNRB , and 2 and 6 weeks post-SNRB . As controls 20 age- and sex-matched normal subjects were tested once . Full departmental , institutional , and ethical committee approval were obtained . Results . Mean DRT of the control group was 452 milliseconds . Mean DRT of patients with right or left radiculopathy pre-SNRB was 521 milliseconds ( P < 0.045 ) and 535 milliseconds ( P < 0.018 ) , respectively . In the right radiculopathic group , the measurements immediately post-SNRB , 2 weeks , and 6 weeks were 656 milliseconds ( P < 0.005 ) , 589 milliseconds ( P < 0.019 ) , and 564 milliseconds ( P < 0.10 ) , respectively . The delay immediately and at 2 weeks post-SNRB translates into an increase in stopping distance of 3.8 and 1.9 m , respectively at the speed of 100 km/h . In the left radiculopathic group , the measurements immediately post-SNRB , 2 weeks , and 6 weeks were 585 milliseconds ( P < 0.037 ) , 534 milliseconds , and 530 milliseconds , respectively . The delay immediately post-SNRB translates into an increase in stopping distance of 1.4 m at the speed of 100 km/h . Conclusion . The study identified significant DRTs ’ changes both in radiculopathy and after SNRB . Right and left radiculopathic patients should be advised about the possible changes in their DRTs post-SNRB . Future research with regard to the suitability for radiculopathic patients to drive and the best time to resume driving post-SNRB is needed Purpose Reduced driving reaction time ( DRT ) has already been studied in context with lumbar disc surgeries . Data on whether cervical spine pathologies impair driving abilities are still lacking . In addition , no return-to-driving recommendations after anterior cervical fusion procedures have been published . Therefore , we assessed DRT before and after anterior cervical discectomy and fusion . Methods We performed a prospect i ve study with 12 patients ( mean age 47.2 years ; female 7 , male 5 ) . DRT as well as arm and neck pain were evaluated before surgery , on the day before discharge from hospital and at the 4–6-week follow-up examinations . 31 healthy subjects were tested for DRT  as a control group . Results All patients showed significant improvement in DRT in the longitudinal course ( p < 0.05 ) . DRT was 601 ms ( median , IQR : 63 ) before surgery , which was reduced to 580 ms ( median , IQR : 112 ) on the day before discharge from hospital and to 532 ms ( median , IQR : 48 ) at follow-up examination . Control subjects had a driving reaction time of 487 ms ( median , IQR : 116 ) , which differed significantly from that of patients at all three testing times ( p < 0.05 ) . VAS for arm and neck pain showed significant improvement ( p < 0.05 ) . Conclusion The present results show a positive effect of anterior cervical discectomy and fusion on driving safety . Based on our data we state that it appears to be safe to resume driving after discharge from hospital . However , patients scheduled to undergo anterior cervical discectomy and fusion  should be informed about increased DRT as compared to healthy individuals Background : Because of specific method ological difficulties in conducting r and omized trials , surgical research remains dependent predominantly on observational or non‐r and omized studies . Few vali date d instruments are available to determine the method ological quality of such studies either from the reader 's perspective or for the purpose of meta‐ analysis . The aim of the present study was to develop and vali date such an instrument BACKGROUND CONTEXT The effect of many types of surgeries on driving reaction time ( DRT ) has been reported . Although lumbar disc herniation is one of the most common spinal diseases , the effect on DRT has not been investigated . PURPOSE To assess the effect of left- and right-sided pareses caused by lumbar disc herniation on DRT before and after surgery . STUDY DESIGN Controlled prospect i ve clinical trial . PATIENT SAMPLE Patients undergoing disc surgery .  OUTCOME MEASURES Impact of paresis caused by lumbar disc herniation and disc surgery on DRT . METHODS Forty-two consecutive patients ( mean age , 50.3 years ) were tested for  DRT  1 day before surgery , postoperatively before hospital discharge , and 5 weeks after surgery . Visual analogue scale ( VAS ) for back and leg pain as well as pain medication and patients ' driving frequency were recorded . RESULTS Significant improvement of DRT after surgery was seen in patients with left- and right-sided pareses ( p<.005 ) . For the right-sided paresis group , the preoperative DRT was 761 ms ( median , interquartile range [ IQR ] : 490 ) , 711 ms ( median , IQR : 210 ) immediately postoperatively , and 645 ms ( median , IQR : 150 ) at follow-up ( FU ) . For the left-sided paresis group , DRT was 651 ms ( median , IQR : 270 ) preoperatively , 592 ms ( median , IQR : 260 ) postoperatively , and 569 ms ( median , IQR : 140 ) at FU . Significant differences between right- and left-sided pareses were identified preoperatively and at FU testing ( p<.005 ) . No correlation was found between VAS for leg or back pain and DRT . Historical control subjects had a DRT of 487 ( median , IQR : 116 ) , which differed significantly at all three test times ( p<.001 ) . CONCLUSIONS A significant reduction in DRT in patients with right- and left-sided pareses was found after surgery , indicating a positive effect of surgery . The improvement in DRT seen immediately postoperatively and the lack of a generally accepted threshold for DRT would suggest that for both patient sample s , it is safe to continue driving after hospital discharge . However , patients should be informed accordingly BACKGROUND The ability to perform an emergency stop is essential for safe driving and can be represented by total brake-response time , reaction time , and braking time . Immobilization of the lower extremities is routinely performed for a variety of musculoskeletal conditions . This study sought to investigate the effect of immobilization with a left-foot driving adapter , a controlled-ankle-motion device , and a short leg cast on braking times . Our hypothesis was that there would be a significant difference in braking-time values between individuals utilizing a left-foot driving adapter or immobilization device  and control individuals wearing normal footwear . METHODS A prospect i ve , observational study was conducted to assess the effect of the immobilization devices on braking times . A driving simulator was used to assess total brake-response time , reaction time , and braking time in thirty-five volunteers . Volunteers were assessed while ( 1 )  wearing normal footwear ( control group  )  , ( 2 ) wearing a controlled-ankle-motion boot , ( 3 ) wearing a removable short leg cast , and ( 4 ) employing a left-foot driving adapter . RESULTS The mean total brake-response time was significantly increased as compared with that of the control group in all three study groups . The mean reaction time was significantly increased for the short leg cast and controlled-ankle-motion groups as compared with reaction time in the control group . The mean braking time was significantly increased in the controlled-ankle-motion and left-foot driving-adapter groups as compared with braking time in the control group . CONCLUSIONS Total brake-response time while wearing a controlled-ankle-motion boot or a short leg cast or while utilizing a left-foot driving adapter is significantly increased , or worsened , as compared with the response time while wearing normal footwear . This information may prove valuable to physicians when counseling patients on when it may be safe to return to driving To assess the potential recovery rate of a  minimally invasive total hip replacement technique  with minimal soft tissue disruption , an accelerated rehabilitation protocol was implemented with weightbearing as tolerated on the day of surgery . One hundred consecutive patients were enrolled in this prospect i ve study . Ninety-seven patients ( 97 % ) met all the inpatient physical therapy goals required for discharge to home on the day of surgery ; 100 % of patients achieved these goals within 23 hours of surgery .  Outpatient therapy  was initiated in 9 % of patients immediately , 62 % of patients by 1 week , and all patients by 2 weeks . The mean time to discontinued use of crutches , discontinued use of narcotic pain medications , and resumed driving was 6 days postoperatively . The mean time to return to work was 8 days , discontinued use of any assistive device was 9 days , and resumption of all activities of daily living was 10 days . The mean time to walk ½ mile was 16 days . Furthermore , there were no readmissions , no dislocations , and no reoperations . Therefore , a rapid rehabilitation protocol is safe and fulfills the potential benefits of a rapid recovery with minimally invasive total hip arthroplasty OBJECTIVE To study the effects of an increase in task complexity on brake response time ( BRT ) in patients undergoing total knee arthroplasty ( TKA ) . DESIGN A prospect i ve repeated- measures design was used . The measurements took place 1 day before and 10 and 30 days after surgery . SETTING Clinic . PARTICIPANTS The data of patients ( N=21 ) who were admitted for primary total arthroplasty of the right knee were pooled for analysis . INTERVENTIONS On each measurement day patients performed 5 practice and 10 test trials for 2 tasks ( 1 simple , 1 complex ) in a car simulator . Task complexity was increased by adding a second movement to the first task performed . MAIN OUTCOME MEASURES BRT , reaction time ( RT ) , and movement time were assessed . RESULTS An increase in task complexity increased BRT , RT , and movement time at all measurement times . Right TKA increased BRT by increasing movement time . Thirty days after surgery BRT was no longer increased compared with preoperative values in both tasks . CONCLUSIONS Task complexity consistently increased BRT and its components . The effects of task complexity remained constant throughout the 3 measurements . After right TKA , we suggest patients should be advised to wait 30 days after surgery before resuming driving We measured the driver reaction times of 40 patients before total knee replacement ( TKR ) and 4 , 6 , 8 and 10 weeks after operation . The ability to perform an emergency stop  was assessed as the time taken to achieve a brake pressure of 100 N after a visual stimulus . There were 18 drivers and 11 non-drivers ; the latter had longer reaction times . In drivers , the ability to transfer the right foot from accelerator to brake pedal did not recover to preoperative levels for eight weeks after right TKR and was unchanged after left TKR . Patients should be advised that they should not drive for at least eight weeks after right TKR This study assessed recovery from open carpal tunnel surgery . One hundred and twelve operations in 75 patients ( 38 unilateral , 37 bilateral ) were review ed prospect ively . A vali date d question naire was completed pre- and postoperatively . Additional information was collected regarding symptom severity at regular intervals following surgery . The time to regain all evaluated activities of daily living was 13 ( range 1–90 , median 7 ) days . Return to driving took 9 days and return to work 17 days , even although exactly half of the patients underwent simultaneous bilateral operations . We did not find any significant differences in the time to resumption of activities of daily living or work between the patients who underwent unilateral or bilateral  procedures , or between those who underwent surgery to the dominant or non-dominant h and .  Overall improvement in symptoms and function was no worse in patients undergoing simultaneous bilateral procedures as compared with unilateral procedures BACKGROUND The aim of this study was to determine whether immobilization of an arm has detrimental effects on driving performance . METHODS Thirty-six healthy officers-in-training were assigned a sequence of fiberglass splints ( left and right-sided above-the-elbow thumb spica and below-the-elbow splints ) with use of a r and omized higher-order crossover design . Runs were scored on a cone-marked driving course used for officer certification with predetermined passing requirements . Driving time , the number of cones hit per course section , and the cone-adjusted total time ( a five-second penalty per hit cone ) were recorded . A linear mixed-effect model with r and om environmental and learning effects for cone-adjusted time analysis was used . Participants rated perceived driving difficulty and safety with each splint , and ratings were compared with the Wilcoxon signed-rank test . RESULTS Thirty participants completed the entire set of runs . Analysis of total cone-adjusted time revealed a significant performance decrease with the left arm in an above-the-elbow thumb spica splint ( average , 22.2 seconds ; p < 0.001 ) and with the left arm in a below-the-elbow splint ( average , 16.2 ; p = 0.007 ) . Analysis of forward-only course sections revealed poorer performance trends with all splints , with the worst performance with the left arm in an above-the-elbow thumb spica splint . Driving with the left arm in an above-the-elbow thumb spica splint had the highest perceived difficulty ( median , 8.0 ) and lowest perceived safety ( median , 3.0 ) . CONCLUSIONS Driving performance as measured with a st and ardized track and scoring system was significantly de grade d with splint immobilization of the left arm . Further studies are required to determine the effect of arm immobilization on normal driving conditions Purpose Although patients scheduled to undergo lumbar disc surgery  often ask when they are allowed to drive a motor vehicle again , there are no published recommendations on this subject . Methods We conducted a prospect i ve study in 46 consecutive patients ( mean age 48.9 years ) to determine driving reaction time ( DRT ) before and after surgery in patients with lumbar disc herniation . Of the patients 23 had left-side radiculopathy and 23 right-side radiculopathy .  Driving reaction time as well as back and leg pain were evaluated preoperatively , on the day of discharge from hospital and at the 5-week follow-up examination ( FU ) . 31 healthy subjects were tested as controls . Results Significant improvement in DRT was seen for both patient sample s ( p < 0.05 ) . For patients with a right-side radiculopathy preoperative DRT was 664 ms ( median , IQR : 241 ) , which was reduced to 605 ms ( median , IQR : 189 ) immediately postoperatively and to 593 ms ( median , IQR : 115 ) at FU . For patients with a left-side radiculopathy DRT was 675 ms ( median , IQR : 247 ) preoperatively , 638 ms ( median , IQR : 242 ) postoperatively and 619 ms ( median , IQR : 162 ) at FU . Pain was moderately correlated to DRT . Control subjects had a driving reaction time of 487 ( median , IQR : 116 ) , which differed significantly from patients at all three testing times ( p < 0.001 ) . Conclusion Our data indicate a positive effect of the surgery on driving ability . Therefore , we would suggest that for both patient sample s it is safe to continue driving after hospital discharge . However , patients have to be informed about increased DRT caused by radiculopathy already before surgery Abstract Purported advantages of THA performed with minimally invasive surgical approaches include less muscle damage and faster recovery . The purpose of this preliminary investigation was to determine if differences existed between minimally invasive approaches in hospital discharge and early functional recovery in THA patients with a rapid rehabilitation protocol . Twenty-four consecutive patients were r and omized to one of three minimally invasive surgical approaches ( two-incision , mini-posterior , and mini-anterolateral )  and enrolled in an aggressive postoperative rehabilitation program .  Hospital discharge , early functional milestone recovery , and vali date d outcome measures ( SF-36 , WOMAC , Harris hip score , lower extremity activity scale ) were collected . All patients met hospital discharge criteria no later than the first postoperative day . There was no difference in hospital discharge , functional milestone recovery , or vali date d outcome measures during the first year after surgery with the numbers available . There were no complications directly related to early hospital discharge or the aggressive rehabilitation protocol . While the data suggest earlier hospital discharge and rapid rehabilitation protocol s may be implemented successfully we found no difference between the three minimally invasive approaches in early hospital discharge or early functional recovery utilizing a rapid rehabilitation protocol . Level of Evidence : Level IV , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence INTRODUCTION A new method of treating acute rupture of the Achilles tendon using polyester tape is reported . This requires no postoperative splintage , allows earlier mobilisation and prompt return to work and sport . PATIENTS AND METHODS Thirty patients were review ed prospect ively and at a mean of 3 years from surgery . RESULTS The average time of return to work , full weight-bearing and to driving was 40 days , 45 days and 49 days , respectively . The average time for return to sport was 122 days . Three patients required further surgery , two for infected wounds and one for scar release . There was one sural nerve injury . Twenty-two patients regained a normal range of ankle and subtalar movement , with the mean power of plantar flexion 84 % of the opposite side . Of the 22 patients who played sport , 14 were still performing at the same or a higher level . There were no re-ruptures over this period . CONCLUSIONS The technique is straightforward and avoids splintage . It also conveys other short- and long-term advantages over more established methods Total knee arthroplasty ( TKA ) dramatically decreases pain and improves mobility and quality of life . However , little has been reported on its effect on driving ability in the early postoperative period . This prospect i ve study was conducted to compare preoperative and postoperative brake response times ( BRTs ) in patients undergoing TKA for osteoarthritis . The results showed that patients returned to preoperative BRT as early as 3 weeks after surgery , and at 9 weeks after surgery , BRTs were significantly improved over baseline . Based on BRT analysis patients undergoing TKA  may be allowed to return to driving 6 weeks after surgery PURPOSE To assess driving ability ( brake response time [ BRT ] ) with commonly used knee braces . METHODS Sixty-four healthy participants ( 32 women and 32 men ) participated in our study . BRT was assessed using a custom-made driving simulator . We assessed BRT for 5 different commonly used knee braces ( right leg ) used in 9 different setting s : without a knee brace ( control group ) ; with a typical postoperative knee brace with adjustable range of motion ( ROM ) and the setting s of 0 ° to 30 ° , 0 ° to 60 ° , 0 ° to 90 ° , and 20 ° to 90 ° ( extension and flexion ) ; and with an unloading knee brace for moderate to severe unicompartmental osteoarthritis , an orthosis for ligament instabilities , a knee brace for patellofemoral disorders , and an elastic knee b and age . RESULTS The 64 participants ( mean age , 33.5 years ) showed significantly impaired BRT with the typical postoperative brace set at an ROM of 0 ° to 30 ° ( 673 milliseconds , P < .001 ) , ROM of 0 ° to 60 ° ( 629 milliseconds , P < .001 ) , ROM of 0 ° to 90 ° ( 607 milliseconds , P = .001 ) , and ROM of 20 ° to 90 ° ( 602 milliseconds , P = .005 ) compared with the control group . However , no such impaired BRT was found for any other investigated knee brace . CONCLUSIONS Right-sided ROM-restricting knee braces involve significant impairment of BRT in healthy participants . No such prolonged BRT was found for a patellofemoral realignment brace , a ligament brace , a valgus/osteoarthritis brace , or an elastic knee b and age . However , our findings should be viewed in light of the limitations of the study , which are ( 1 ) the lack of a defined decrease in BRT that could lead to an accident and ( 2 ) uncertainty of whether the statistical differences are also clinical ly important . LEVEL OF EVIDENCE Level II , lesser- quality r and omized controlled trial Study Design . Controlled prospect i ve study . Objective . To determine whether driving reaction time ( DRT ) is influenced by primary lumbar fusion . Summary of Background Data . The effects of radiculopathy and nerve root blocks on DRT have been reported recently . To our knowledge , the relationship between lumbar fusion and DRT has not been previously studied although it is important for driving safety . The aim of the present study was to test the hypotheses that DRT after lumbar fusion is ( 1 ) altered after the operation , ( 2 ) influenced by pain , ( 3 ) influenced by the patient 's driving skill , and ( 4 ) differs from the DRT of healthy controls . Methods . Twenty-one consecutive patients ( mean age , 53.5 years ; SD 10.8 ) receiving primary lumbar fusion were tested for their DRT 1 day before surgery ( preoperative ) , the day before discharge ( postoperative ) and 3 months after surgery ( follow-up ; FU ) .  DRT  was assessed using a custom-made driving simulator . The severity of back pain was determined on visual analogue scales separately for usual pain ( VAS-U ) and pain during testing ( VAS-T ) . We also determined the patients ' subjective driving frequency . Normative DRT data from 31 age-matched healthy controls were used for comparison . Results . The preoperative DRT was 685 milliseconds ( Md ; IQR 246 ) and the postoperative DRT 728 milliseconds ( Md ; IQR 264 ) , which was further reduced to 671 milliseconds ( Md ; IQR 202 ) after the FU period . Statistical significance was registered between postoperative and FU DRT ( P = 0.007 ) . Moderate to high correlations ( 0.537 < r < 0.680 ) were found between the VAS rating of back pain and DRT . Control subjects had a DRT of 487 milliseconds ( Md ; IQR 116 ) , which differed significantly from the DRT of patients at all 3 time points of testing ( P < 0.001 ) . Conclusion . It appears safe to continue driving after discharge from the hospital following lumbar fusion . DRT improved significantly during FU , indicating a positive effect of the intervention on driving skills . DRT correlates with the severity of back pain Old studies recommend 6weeks post-operative before patients can return to driving safely . This is a prospect i ve study assessing brake reaction time ( BRT ) after THA  . 38 patients underwent a pre-operative , 2  ,  4 and 6weeks post-operative BRT test . General linear repeated measurement was used . The mean pre-operative reaction time was 0.635±0.160seconds SD and 2-week was 0.576±0.137seconds SD ( P=0.029 ) ; 33 patients ( 87 % ) were able to reach their baseline time by 2weeks . The remaining five patients ( 13 % ) reached their baseline at the 4-week post-operative . No differences were found with respect to age , gender , and the use of assistive devices . With new techniques in THA , most of patients return to normal times within the 2-week
target: Observer-reported outcome measures showed that patients ’ driving abilities often are impaired when wearing an immobilizing cast above or below the elbow or a shoulder sling on their dominant arm .
  Conclusions The available evidence provides a best-case scenario for when patients can return to driving .
  Survey data suggest that patients are returning to driving before observer-reported outcome measures have normalized , indicating that physicians should tell patients to wait longer before driving .
background: Background Patients often ask their doctors when they can safely return to driving after orthopaedic injuries and procedures , but the data regarding this topic are diverse and sometimes conflicting .
  Some studies provide observer-reported outcome measures , such as brake response time or simulators , to estimate when patients can safely resume driving after surgery , and patient survey data describing when patients report a return to driving , but they do not all agree .
  We performed a systematic review and quality appraisal for available data regarding when patients are safe to resume driving after common orthopaedic surgeries and injuries affecting the ability to drive .
  Questions / purpose sBased on the available evidence , we sought to determine when patients can safely return to driving after ( 1 ) lower extremity orthopaedic surgery and injuries ; ( 2 ) upper extremity orthopaedic surgery and injuries ; and ( 3 ) spine surgery .