To the Editor: The article by Schofferman et al, “Chronic Whiplash and Whiplash-Associated Disorders: An Evidence-Based Approach,”1 deserves comment. First, the term whiplash is no longer accepted by most orthopaedic surgeons. The mechanism of injury is not at all reflected by that term. It was, in fact, the subject of an apology by its originator, Harold Crowe, MD.2
Second, there may be some bias in the selection of evidence because many studies cited could be contradicted by other studies.2,3 This suggests that there may well be no such injury as we construe it.
Third, the authors' citation of autopsy findings of disk injury imply, at least, that impact resulting in death was somewhat greater than the average rear-ender. A truly evidence-based approach might not support such a specific cause of these very common lesions.
Finally, the citation of placebocontrolled studies as level I evidence does not seem to be in accord with the standards of the Journal of Bone and Joint Surgery.
Clifford C. Raisbeck MD
San Francisco, CA