What’s Important: Take a Knee: Our Collective Responsibility to Dismantle Systemic Racism : JBJS

Journal Logo

The Orthopaedic Forum

What’s Important: Take a Knee

Our Collective Responsibility to Dismantle Systemic Racism

Walker, Gregory T. Jr. MD1,a; Taylor, Mario A. MD1; Chansky, Howard A. MD1

Author Information
The Journal of Bone and Joint Surgery 103(1):p 92-94, January 6, 2021. | DOI: 10.2106/JBJS.20.01505
  • Free
  • Disclosures

It has been 4 years since National Football League (NFL) quarterback Colin Kaepernick famously knelt during the playing of the U.S. national anthem. Kaepernick never wavered in his explanation of his action: to “take a knee” was his silent and peaceful means of protesting against social injustice and, more specifically, systemic police brutality against the African-American community. At the time, Kaepernick stated that “I am not going to stand up to show pride in a flag for a country that oppresses black people and people of color.…There are bodies in the street.”1 Kaepernick’s taking a knee during the national anthem was in protest of systemic racism and police brutality, not an act of “disrespect” to the national anthem or the American flag. Yet his manner of protest was immediately met with backlash, and he was accused of being anti-American and disrespectful to the flag. The cries of injustice from the disfranchised communities that supported him would soon be drowned out by shouts of “Make America Great Again.”

Four years and several alarming viral videos later, it is clear that the stain of racism is still very much a part of America’s identity. It seems that, almost every day, another cell phone video is disseminated, proving Kaepernick’s point. This past summer saw widespread protests in response to the recorded killing of George Floyd, a Black man, by police in Minneapolis, Minnesota. A police officer, who swore to protect and serve his community, pressed his knee against George Floyd’s neck and throat for more than 8 minutes, crushing the life out of him as he cried for mercy. It was a death so horrific that it is natural to want to think of it as an isolated incident. Unfortunately, events similar to that one continue to occur far too frequently. While it is encouraging that protests and calls for reform have gained momentum, our Black communities’ cries for mercy, change, and justice have gone unheard for far too long.

But maybe you aren’t convinced that change is needed? A recent study by Edwards et al. investigated how the lifetime and age-specific risks of being killed by police vary across gender and race2. The authors found that African-American and American Indian/Alaska Native men and women and Latino men face a higher lifetime risk of being killed by police than do their White peers. They estimated that some 52 of every 100,000 males of any race will be killed by the use of force by police. However, the lifetime mortality risk for African-American men is about 2.5 times that of White men. Police brutality against minorities is coupled with increasing militarization of our nation’s police forces, creating a particularly dangerous combination. Between 2006 and April 2014, the U.S. Department of Defense transferred over $1.5 billion worth of equipment to local law enforcement agencies across America. The agencies that received military-grade equipment were more likely to have violent interactions with the general public3.

Maybe you believe that change is needed, but you disagree with the methods, a position originally articulated by New Orleans Saints quarterback Drew Brees. Brees stated that the American flag is “sacred” and that by kneeling during the national anthem, one is “disrespecting that flag that has given you the freedom to speak out.”4 In the 4 years since Colin Kaepernick began his nonviolent campaign against police brutality targeting Black Americans—a 4-year period marked by the deaths of Botham Jean, Philando Castile, Breonna Taylor, George Floyd, and many others—little has changed. More recently, Brees again stated that protesting during the national anthem was disrespectful, although following public outcry and protestation from White and Black athletes and teammates, Brees soon after apologized for his remarks. He acknowledged that his comments “lacked awareness and any type of compassion or empathy.”5 Brees, a well-established philanthropist, has been faithful in giving back to the poor and underprivileged communities of New Orleans, and we applaud him for his recent change of heart. However, we hope that he and others recognize that commendable deeds and pronouncements do not absolve one of the imperative to actively combat racism. Statements and quiet deeds in support of decimated Black communities are welcomed, but when divested of efforts to publicly and directly challenge structural racism, they may do more to assuage the feelings of well-meaning White citizens than to aid our nation’s Black citizens. Without efforts to call out and dismantle structural racism, these statements and deeds are equivalent to stating, “I understand how you feel, but protest on my terms so that I can feel more virtuous and comfortable.”

Such comments eerily echo sentiments held by many Americans during the 1960s regarding the Civil Rights Movement. A 1966 Gallup poll found that two-thirds of Americans had an unfavorable opinion of Dr. Martin Luther King Jr., who, in 1964, had won the Nobel Peace Prize as a direct result of his employing nonviolent civil disobedience to effect political change6. King regularly criticized the government and police departments for their failures to protect Black communities. Dr. King pointed his finger at the dominant White majority in his 1963 “Letter from Birmingham City Jail”7:

“I have been gravely disappointed with the white moderate. I have almost reached the regrettable conclusion that the Negro’s great stumbling block in the stride toward freedom is not the White Citizen’s Counciler or the Ku Klux Klanner, but the white moderate who is more devoted to ‘order’ than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says ‘I agree with you in the goal you seek, but I cannot agree with your methods of direct action….’”

How would Dr. King respond to those who criticize Colin Kaepernick and other professional athletes for taking a knee in peaceful protest against systemic racism and police violence against the Black community? Does this not align with the “white moderate” that Dr. King addressed in 1963? We believe that it does.

Honest Reflection and Embracing Discomfort

As surgeons and educators, we regularly take part in morbidity and mortality conferences. For those whose cases are being discussed, even though not the intent, these conferences can become wildly uncomfortable and, on occasion, we feel a sense of shame. Nevertheless, we persist because we know that honest reflection is vital for the continuing improvement of patient safety and our own clinical skills. Growth is an uncomfortable process, and discomfort is a necessary investment if there is to be progress. So if watching professional athletes kneel during the national anthem makes you uncomfortable, if talking about racism makes you uncomfortable, if watching Americans protesting in the streets makes you uncomfortable, if watching the life leave the body of a Black man being strangled by police officers as he cries for his mother makes you uncomfortable, then we implore you in the spirit of self-improvement, shared humanity, and compassion, do not turn away. Embrace the discomfort and listen to the Black community and your colleagues of color. This is a critical step toward self-reflection and commitment toward being a part of the solution to racial injustice.

The NFL has missed the mark for 4 years and perhaps longer, but we don’t have to. We can change. Now is the time for action. Now is the time to stand up for justice. Now is the time to demand the end of police brutality and systemic racism. Take your usual excellent care of the neediest in your community to another level. Ask your leaders in government, and your colleagues, what they are doing to address systemic racism and let them know that their words and actions are important. Our profession is not immune to racial inequalities. Prior studies investigating common orthopaedic procedures have shown racial disparities in access to pain-relieving surgeries and overall outcomes8–12. Demand change. Continue to advocate for diversity in the profession of orthopaedic surgery and combat biases in our health-care system that directly impact the care of our patients.

It is clear that we are in the midst of not 1 but 2 pandemics: coronavirus disease 2019 (COVID-19) and the virulent contagion of systemic racism. Both are disproportionately affecting Black communities. Both are detrimental to the health and well-being of our patients whom we have sworn to help. As orthopaedic surgeons, and as leaders in medicine and in our communities, we must be at the vanguard of change. We must acknowledge systemic racism and actively work to dismantle it without delay. We should all take a knee.


1. Payne M. Colin Kaepernick refuses to stand for national anthem to protest police killings. The Washington Post. 2016. Accessed 2020 Oct 20. https://www.washingtonpost.com/news/early-lead/wp/2016/08/27/colin-kaepernick-refuses-to-stand-for-national-anthem-to-protest-police-killings/
2. Edwards F, Lee H, Esposito M. Risk of being killed by police use of force in the United States by age, race-ethnicity, and sex. Proc Natl Acad Sci U S A. 2019 Aug 20;116(34):16793-8. Epub 2019 Aug 5.
3. Delehanty CMJ; Welch R, Wilks J. Militarization and police violence: the case of the 1033 program. Research & Politics. 2017;4(2).
4. Triplett M. Drew Brees 'wholeheartedly' disagrees with Colin Kaepernick’s method of protest 2016. Accessed 2020 Oct 20. https://www.espn.com/blog/new-orleans-saints/post/_/id/23063/drew-brees-wholeheartedly-disagrees-with-colin-kaepernicks-method-of-protest
5. Foley A. Drew Brees issues lengthy apology for 'insensitive' remarks lacking 'awareness'.' 2020. Accessed 2020 Oct 20. https://thehill.com/blogs/in-the-know/in-the-know/501088-drew-brees-on-comment-about-disrespecting-flag-i-have-always
6. Jones JM. Americans divided on whether King’s dream has been realized. 2011. Accessed 2020 Oct 20. https://news.gallup.com/poll/149201/americans-divided-whether-king-dream-realized.aspx
7. King ML. Letter from Birmingham City Jail. Eight serigraph prints by Faith Ringgold. New York: Limited Editions Club; 2007.
8. Ali I, Vattigunta S, Jang JM, Hannan CV, Ahmed MS, Linton B, Kantsiper ME, Bansal A, Srikumaran U. Racial disparities are present in the timing of radiographic assessment and surgical treatment of hip fractures. Clin Orthop Relat Res. 2020 Mar;478(3):455-61.
9. Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015 Dec;105(12):e60-76. Epub 2015 Oct 15.
10. Hausmann LRM, Brandt CA, Carroll CM, Fenton BT, Ibrahim SA, Becker WC, Burgess DJ, Wandner LD, Bair MJ, Goulet JL. Racial and ethnic differences in total knee arthroplasty in the Veterans Affairs Health Care System, 2001-2013. Arthritis Care Res (Hoboken). 2017 Aug;69(8):1171-8. Epub 2017 Jul 10.
11. Bang H, Chiu YL, Memtsoudis SG, Mandl LA, Della Valle AG, Mushlin AI, Marx RG, Mazumdar M. Total hip and total knee arthroplasties: trends and disparities revisited. Am J Orthop (Belle Mead NJ). 2010 Sep;39(9):E95-102.
12. Singh JA, Lu X, Rosenthal GE, Ibrahim S, Cram P. Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data. Ann Rheum Dis. 2014 Dec;73(12):2107-15. Epub 2013 Sep 18.

Supplemental Digital Content

Copyright © 2020 by The Journal of Bone and Joint Surgery, Incorporated