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Letter to the Editor

Editorial

Do Orthopaedic Surgeons Belong on the Sidelines at American Football Games?

Kweon, Christopher Y. MD; Scheidegger LAT, Robert I.; Gee, Albert O. MD; Chansky, Howard A. MD

Clinical Orthopaedics and Related Research®: January 2018 - Volume 476 - Issue 1 - p 172–173
doi: 10.1007/s11999.0000000000000047
LETTERS TO THE EDITOR
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C. Y. Kweon, Assistant Professor, Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA USA

R. I. Scheidegger, Associate Athletic Trainer/Head Football Athletic Trainer, Department of Intercollegiate Athletics, University of Washington, Seattle, WA USA

A. O. Gee, Assistant Professor, Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA USA

H. A. Chansky, Professor and Chair, Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA USA

Albert O. Gee MD University of Washington 3800 Montlake Bvld NE Box 354060 Seattle, WA 98195-4060 USA e-mail: ag112@uw.edu

(RE: Leopold SS, Dobbs MB, Gebhardt MC, Gioe TJ, Rimnac CM, Wongworawat MD. Editorial: Do orthopaedic surgeons belong on the sidelines at American football games? Clin Orthop Relat Res. [Published online ahead of print September 5, 2017]. DOI: 10.1007/s11999-017-5483-6.)

One author (CYK) is a Team Physician for the Washington Huskies.

One author (RIS) is a Head Football Athletic Trainer for the Washington Huskies.

One author (AOG) is a Team Physician for the Washington Huskies.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

To the Editors,

We read with interest the recent thoughtful editorial from Leopold and colleagues [1]. If the recommendation of the editors—that orthopaedic surgeons should not be present on the sidelines—was made to bring more focus on an aspect of sports medicine and society that clearly needs more attention, we hope the editors succeed. If the recommendation was made because the editors actually want orthopaedic surgeons to refrain from medical coverage of football games, the decision marks a deviation of the editorial board’s typical consideration of best evidence as well as important contextual and practical information to make recommendations that represent the ideals of our profession.

While chronic traumatic encephalopathy (CTE) is a condition that has garnered significant attention within medicine, as well as in the media over the last 5 years, we still do not fully understand its pathophysiology, causes, and clinical manifestations. Studies demonstrate associations between playing football and having pathologic or clinical signs of CTE, and we do not doubt that these associations are real [2, 3]. However, the relationships between playing football, sustaining concussions, the development of pathologic evidence of CTE, and the development of clinical signs of mental illness are still uncertain.

The editors acknowledge that the effect that orthopaedic surgeons’ recusal from football team coverage might achieve may be limited, but that the professional obligation to these at-risk players is more important [1]. If we feel that driving under the influence of alcohol is a risky activity, more dangerous than football with clearer associations and immediate consequences [4, 5], would our professional obligation be to stop attending social events where alcohol is served in order to demonstrate that we do not support this activity because of its potential consequences? We believe that our influence as orthopaedic surgeons is better utilized by continued focus on the activities that can make a difference to an athlete’s health, activities such as counseling players, coaches and parents of youth athletes about the known and potential risks of playing contact sports. Remaining intimately involved with teams, including sideline coverage, is our best opportunity to partner with our allied health partners who have more consistent contact with our athletes, and our best opportunity to educate coaches, players and parents about the risks of rushing the recovery of athletes from concussions and other sports injuries.

In addition, most injuries suffered during the course of a football game are not to the head, but to the musculoskeletal system. Would a football player with a C-spine injury or an appendicular fracture-dislocation not be better served if an orthopaedic surgeon were available to assist in the acute care of these injuries—with our understanding of not only on-field management but also our understanding of the surgical care of these life- or limb-threatening injuries? Removing ourselves from game coverage would mean abandoning athletes with these and other significant orthopaedic injuries at a time when we may positively impact their clinical outcomes.

We laud the CORR® editorial board for a thought-provoking stance that will foster more public discussion and interest in research to better understand, prevent, and treat concussions and CTE. We also hope that this editorial will stimulate further efforts to educate youth, college, and professional football players and coaches regarding the risks of concussions sustained while playing. However, the natural history of concussions and CTE are not fully understood, and society continues to broadly support organized youth and adult football. In contrast to the CORR® editorial board’s opinion regarding sideline coverage of football games, we believe that our professional obligation as orthopaedic surgeons is to be on the sidelines rather than withdraw in protest. By doing this, we can continue to make a real difference in the lives of athletes by caring for them as players and patients and by engaging and educating them about the best evidence regarding risks of sports-related injuries including concussions and musculoskeletal injuries. By abandoning coverage of football games, we reduce our ability as individuals and as a profession to influence rules and policies regulating the safety of amateur and professional football.

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References

1. Leopold SS, Dobbs MB, Gebhardt MC, Gioe TJ, Rimnac CM, Wongworawat MD. Editorial: Do orthopaedic surgeons belong on the sidelines at American football games? Clin Orthop Relat Res. [Published online ahead of print September 5, 2017]. DOI: .
2. Maroon JC, Winkelman R, Bost J, Amos A, Mathyssek C, Miele V. Chronic traumatic encephalopathy in contact sports: A systematic review of all reported pathological cases. PLoS One. 2015;10:e0117338.
3. Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, Alosco ML, Solomon TM, Nowinski CJ, McHale L, Cormier KA, Kubilus CA, Martin BM, Murphy L, Baugh CM, Montenigro PH, Chaisson CE, Tripodis Y, Kowall NW, Weuve J, McClean MD, Cantu RC, Goldstein LE, Katz DI, Stern RA, Stein TD, McKee AC. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318:360–370.
4. National Federation of State High School Associations. 2015–2016 high school athletics participation survey. Available at http://www.nfhs.org/ParticipationStatistics/PDF/2015-16_Sports_Participation_Survey.pdf. Accessed October 9, 2017.
5. National Highway Traffic Safety Administration’s National Center for Statistics and Analysis Traffic Safety Facts 2015 Data. Available at https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812413. Accessed October 9, 2017.
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