Due to CTE risks for players, editorial asks orthopedic surgeons to rethink their support of football

According to an editorial from Clinical Orthopaedics and Related Research, orthopedic surgeons should re-evaluate their support of American football as a recently published study in JAMA suggested exposure to the sport was linked with pathological changes in the brain.

Perspective from B. Sonny Bal, MD, MBA

“Individual athletes will decide what sports they will play, and I believe that individual surgeons can — and should — decide whether they are doing more benefit than harm by supporting football with their professional presence, since that sport appears to carry a real risk of permanent neurocognitive impairment,” Seth S. Leopold, MD, editor-in-chief of Clinical Orthopaedics and Related Research, told Healio.com/Orthopedics. “Orthopedic surgeons of course will treat whoever comes to the office or emergency room, regardless of how they were injured, but standing on the sidelines (and the other kinds of involvement we mention in the editorial) ties us to the activity in ways that I do not think are consistent with our best professional values.”

Leopold and colleagues based their opinion on a recent study published in JAMA. In that study, researchers performed a case series on the donated brains of 202 deceased football players who had participated in all levels of American football. Investigators conducted neuropathological evaluations and retrospective clinical assessments for evidence of traumatic encephalopathy (CTE).

Results from the study demonstrated 48 college football players out of 53, developed CTE and 110 National Football League players out of 111 developed CTE. The high proportion of CTE evidence suggested CTE may be linked with prior participation in the sport. In athletes with mild and severe CTE pathology, researchers found behavior, mood and cognitive symptoms were common. Suicidality and history of psychiatric illness were common among players with these symptoms.

“But if orthopedic surgeons stopped covering football teams, other physicians might likewise hesitate or withdraw their support, and the result could well be genuine changes at all levels of the sport, and a real reduction in the number of individuals experiencing irreversible brain injury,” the authors wrote. – by Monica Jaramillo

References:

Leopold SS, et al. Clin Orthop Relat Res. 2017; doi:10.1007/s11999-017-5483-6.

Mez J, et al. JAMA. 2017:doi:10.1001/jama.2017.8334.

Disclosure: Leopold reports no relevant financial disclosures.

Perspective

B. Sonny Bal, MD, MBA

Football, a popular sport in the United States, has always carried the risk of physical injury. Most of those injuries are amenable to treatment, usually through the timely intervention of orthopedic surgeons who, as the CORR editor’s note, are almost always on the sidelines.

Chronic traumatic encephalopathy (CTE) is in an entirely different realm than physical injury. Players and their families cannot reasonably anticipate a lifetime of disability or the severity of a progressive neurological disease that can have serious, life-altering or even life-threatening outcomes for football players. Even if they anticipate CTE and its sequelae, financial and other pressures may influence the decision to roll the dice and take the risk.

The high ideals of our profession deserve protection; public trust and respect is built upon a visible adherence to those values, manifested in the actions of our peers. It is up to the players to risk their health for a chance at their dreams, with millions to be made; they are independent agents who can decide where their interests may be. It is also true that endorsements and the brand identification with major teams can be a lucrative and fulfilling proposition for orthopedic surgeons who are team physicians. But, just as players have a choice, so does the orthopedic profession. A long time ago, society honored and glorified now-obsolete sports, such as gladiator combat, bear-baiting, execution of criminals or animals in the sports ring, horse-back jousting and others, that carried serious risk of injury or death. With awareness and knowledge, these blood sports have disappeared from modern civilization and we are no worse off.

The CORR editors take a courageous stand in their moral clarity by asking for our profession to distance itself from modern football, a sport whose ill-effects on players are now being recognized and acknowledged. There will be those who disagree against this stance, but the ethics and foundations of our profession demand no less. I may add that orthopedic surgeons and institutions should also support additional research into the injuries caused by football and participate in efforts to modify the game or design safety strategies that recognize our obligation to players as patients, first and foremost, rather than agents of economic gain, entertainment or self-promotion. Until then, the CORR editors have it entirely correct; orthopedic surgeons must display through their actions, their first and foremost obligation toward the safety of their patients. Society expects nothing less from us.

B. Sonny Bal, MD, MBA

Orthopedics Today Editorial Board Member

Disclosures: Bal reports no relevant financial disclosures.