Today a soldier injured on the battlefield has the highest chance of survival in history. The wounded-to-killed ratio has more than doubled, from 4:1 during the last century’s world wars, to 10:1 in the current conflicts, despite an increase in the severity and complexity of wounds. Perhaps, more impressive than the survival rate of combat causalities, is the ability of those with severe injuries to return to a level of function that allows for continued military service and even deployment. Since 2001, there have been more than 1600 major extremity amputations. One out of every 5 of those return to full military duty—a milestone that has not been previously accomplished in such great numbers in past conflicts.
The rate of non–combat-related injuries in deployed service members is equally eye opening, both for its frequency and relatively unchanged burden through history. Since the earliest military conflicts, 80% of casualties have come from noncombat injuries. In WWI, diseases like trench fever and dysentery were dominant, and nonbattle conditions accounted for ~80% of injuries. Yet, our most recent experiences in Iraq and Afghanistan are unchanged—80% of casualty evacuations are for nonbattle injuries, and the most common diagnosis is a noncombat musculoskeletal injury.
While the injuries sustained during deployment have been of particular interest, the injures that occur during everyday military activities remain a significant problem. The former Surgeon General of the US Army, Major General James Peak, MD, described nonbattle injuries, and specifically musculoskeletal injuries, as the hidden epidemic in the US Military. In our soldier-athletes, ACL tears, shoulder dislocations, and similar injuries occur at increased frequencies compared with the civilian population.
The burden of injuries sustained in combat and noncombat environments, as well as the high functional requirements of military personnel, has fostered an area of research surrounding the tactical athlete. Optimizing performance of the tactical athlete requires a comprehensive approach to address both the mental and physical aspects of performance, in addition to the unique military requirements. The articles presented in this edition of The Warrior Athlete highlight current efforts to return the professional tactical athlete to military duty.
It has been an honor to contribute to this edition of Sports Medicine Arthroscopy Review. We are thankful for all the authors’ contributions and their efforts in this issue to advance the care for our military service members.