What is orthopaedic sports medicine? Where do its practitioners fit into the emerging community of sports and exercise medicine (SEM), and most importantly, what role should the speciality play on the international stage?

If you pose the first of these questions to some (many?) surgically focused SEM professionals, you will probably get the sort of answers that reflect the “Wikipedia” approach.

“sports medicine” … encompasses a group of professionals from various disciplines whose focus is the health of an athlete…. Orthopaedic sports medicine is the investigation, preservation, and restoration by medical, surgical, and rehabilitative means to all structures of the musculoskeletal system affected by athletic activity [1].

Is it all about the treatment of injured athletes? As the conversation progresses, the picture emerges of doctors who see themselves rushing on to the field of play to rescue David Beckham’s Achilles tendon, Wayne Rooney’s fractured metatarsal or some similarly high-profile sportsperson with an injury that disrupts a televised competitive event. So, it’s not just athletes but ‘elite’ athletes?

Why should anyone be worried about this?

Firstly, because this caricature undersells the clinical realities. When you ask the same people about their day-to-day practice, they readily admit that they are more likely to see the soccer-mom who twisted her ankle sprinting along a muddy touchline than the elite athlete injured in actual combat. And for the most part orthopaedic sports medicine is just one of the things they do in their daily job as an orthopaedic surgeon.

Secondly, just because many patients seeking help are not athletes doesn’t mean that sports orthopaedics has nothing to contribute to their treatment. Wayne Rooney chose the removable plastic cast over the traditional plaster cast. ‘Removable plastic casts provide compression which limits swelling and the rocker sole allows early weight bearing … Research has shown that early weight bearing helps to speed fracture healing…’ [2] No doubt, in the weeks that followed Rooney’s 2006 injury, every patient attending Manchester’s fracture clinics asked why they couldn’t have a cast like the one Wayne Rooney had.

Thirdly, because orthopaedic sports medicine risks missing strategic opportunities to influence patient care on a widespread basis if it fails to see the bigger picture.

According to the International Federation of Sports Medicine [3], Sports Medicine is a discipline… ‘…embodying theoretical and practical medicine which examines the influence of exercise, training and sports, as well as the lack of exercise, on healthy and unhealthy people of all ages to produce results that are conducive to prevention, therapy and rehabilitation as well as beneficial for the athlete himself’.

The number of athletes (elite or otherwise) is dwarfed by the vast numbers of sufferers from osteoporosis, arthritis, type 2 diabetes, war injuries. All of these patients may benefit in some way from the knowledge and skills of SEM doctors in general or orthopaedic sports surgeons in particular. For that benefit to be a reality, three key elements need to be highlighted in the orthopaedic sports paradigm:

45.1 Perspective

Athletes (especially elite athletes) are a (young, fit, healthy…) means to developing treatments for wider populations of patients, not the sole end of treatment in themselves. This is absolutely not to deny their needs as patients, but their celebrity should illuminate rather than obscure wider needs. Athletes can be partners, not just patients.

45.2 Prevention

Diagnosis of an injury or condition and its treatment plan should contribute wherever possible to the prevention of such injuries in the future. In a 2016 Orthopaedic Sports Medicine conference [4], only three of the 21 papers presented (35 min of 12.5 h of conference time) focused on prevention.

45.3 Advocacy

At the heart of a medical vocation is the doctor’s role as advocate for the patient. Orthopaedic sports practitioners have a key role to play as patient advocates in both innovation and education. The ‘technology and tools’ focus in orthopaedics is arguably responsible for much of its success as a speciality. This goes beyond the plates, screws, implants and the tools to manipulate them to the complexities and depth of the network of international educational programmes that draws the community together. It is one thing to build the scientific platform that identifies the need for the plastic removable cast that returned Wayne Rooney so efficiently to the soccer pitch. It is quite another leap of advocacy to campaign for that cast to be produced in sufficient numbers and at sufficiently low cost that landmine victims in Afghanistan can benefit from it in the same way.

A 2019 Orthopaedics Sports education conference describes its focus as ‘Keeping Patients Active Through Biologics, Rehabilitation& Contemporary Surgical Techniques’ [5].

This vision that highlights the focus on patients may be one that enables orthopaedic sports medicine to re-affirm its holistic mission to care for all patients, not just the athletes?