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Driving

  • There are no well-established guidelines for determining when it is safe to drive after injury or treatment.  In general, law enforcement agencies determine what constitutes impaired driving on a case-by-case basis and place responsibility for the decision to drive on the patient. (Marecek GS, JAAOS 2013;21:696).  The decision to return to driving should be individualized to each patient.
  • Patients should not drive if they are wearing a protective device (splint, cast, brace, etc.) that limits joint mobility or are taking narcotic pain medication, or other medications that may cause drowsiness
  • Braking function returns to normal 4 weeks after knee arthroscopy, 6 weeks after right ACL reconstruction, 2 weeks after left ACL reconstruction, 9 weeks after surgical management of ankle fracture, and 6 weeks after the initiation of weight bearing following major lower extremity fracture. (Marecek GS, JAAOS 2013;21:696)
  • Federal Highway Administration (FHWA) has designated 700 milliseconds as a safe threshold for braking reaction time. 
  •   Estimated Safe Return to Driving
    Knee Scope 4 weeks
    Right ACL recon 6 weeks
    Left ACL recon 2 weeks
    ORIF Ankle fracture 9 weeks
    LE fracture 6 weeks after full weight bearing
    ORIF LE articular fracture 18 weeks
    TKA 4-6 weeks
    THA 4-6 weeks
       
  • No driving with a cast or brace on the right leg or elbow immobilization. (Marecek GS, JAAOS 2013;21:696)
  • TKA: may drive at 4-6 weeks. (Pierson JL, J Arthroplasty 2003;18:840).  Braking times return to baseline levels within 4 weeks of surgery, but only at speeds slower than 43.5mph. (Dalury DF, Clin Orthop Relat Res. 2011 Jan;469(1):82-6).  (Huang HT, BMC Musculoskelet Disord. 2014 Jun 10;15:198.)
  • THA: may drive at 4-6 weeks.
  • Knee arthroscopy:  1 week postop breaking reaction time increased to 920 milliseconds and dropped to 685 milliseconds by 4 weeks. (Hau R,  Knee Surg Sports Traumatol Arthrosc. 2000;8(2):89-92).
  • It is recommeded that patients retest with the state department of motor vehicles before returning to drive. Doctors no longer “clear” patients for driving, no matter how long it has been since the injury or surgery. Document discussion of driving recommendations in the patient’s medical record. AAOS now article April 2009.
  • Consider providing patients with a referral to a return-to-driving program managed by independent occupational therapy services.
  • Immobilization of the right leg with a walking cast and an Aircast walking boot decreases braking force and braking reaction times as compared to a tennis shoe. (Tremblay MA, JBJS 2009;91:2860).
  • Physicians should not make determinations regarding the safe operation of a vehicle. A doctor should not "clear" or "release" a patient to drive a car. Doctors can recommend that driving is unsafe, but  can not make a legal determination of when it is safe to drive. The legal determination of who is safe to drive is made by the Department of Motor Vehicles.

References:

  • Chen V, et al. JBJS. 2008;90A:2791-2797.  Pollack P. "Wearing arm splint affects driving ability" AAOS Now. Vol 4, No 1. January 2010. Page 11.
  • Marecek GS, JAAOS 2013;21:696
  • Hau R, Csongvay S, Bartlett J. Driving reaction time after right knee arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):89-92.  
  • Marecek GS, Schafer MF. Driving after orthopaedic surgery. J Am Acad Orthop Surg. 2013 Nov;21(11):696-706. doi: 10.5435/JAAOS-21-11-696.  

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