The Forward Movement: Amplifying Black Voices on Race and Orthopaedics—It’s Not “Just A Sprain”

I recently performed an ACL reconstruction on an elite high school basketball player. Not long after the operation, a journalist from the player’s hometown newspaper called me with his parents’ permission. The gravity of the high-flying guard’s injury was felt not just by the player, but by his entire community, and the journalist wanted to have a better understanding of ACL injuries and perhaps a timetable for the player’s return.

We reviewed the typical topics one would expect to discuss with a member of the media. After the softballs, the journalist got to the point: “Why did it take over 3 months for the player to get an MRI after his injury?”

My patient landed awkwardly in a December game and felt his knee give way. Despite immediate pain and swelling, the player did not get an MRI until April. His parents sought medical attention right away, but their concerns were dismissed by multiple urgent care providers. They were told it was “just a sprain.”

The player pushed through the discomfort and returned to the court, but it was clear that instability limited his play. This previously explosive athlete could barely make it up and down the floor, let alone perform the authoritative dunks that would get the crowd on its feet. The player made his way to me only after his mother forced the issue and demanded an orthopaedic evaluation. “You are the first provider to make us feel heard,” his mother told me.

I think back to the reporter’s question. The journalist (who is Black) and this Black mother are wondering why it took so long for this Black man to receive the proper diagnosis for his condition.

In a previous column, I discussed how disparities in the perception of pain for Black patients limits access to orthopaedic care [6]. This point remains relevant when discussing inequality in sports medicine injuries. One study found racial bias in sports medicine staff members’ perceptions of pain among Black athletes with ACL injury [3]. Logic dictates that biases such as these play a central role in the recent findings of greater surgical delay for Black patients undergoing ACL reconstruction [1]. Stated plainly, if Black athletes are more likely to be told “it’s just a sprain,” the likelihood of delay to ultimate diagnosis is far greater. Given the clear connection between delayed ACL treatment and concomitant knee injury [4], it is fair to say that minimizing an athlete’s initial symptoms may have lasting consequences for his or her entire life. As is the case in all aspects of medicine, biased attitudes that might be considered innocuous to some can have devastating long-term consequences.

But the player did not need this study to tell him what he already knew. Neither did his mother. Neither did the Black journalist asking the question. Frankly, neither did I. We all knew what had occurred. The fact that my patient is a Black man dramatically increased the odds that his serious injury was written off by multiple providers. It took his mother’s advocacy and tenacity to finally obtain the appropriate diagnosis.

The healthcare system, as currently constructed, keeps many of our Black athletes from getting appropriate and timely care. This system was built over the course of centuries and will not be dismantled quickly or easily. However, we as providers can take specific steps to empower patient-athletes with the knowledge to effectively advocate for themselves. Just as many young athletes have used social media to increase their agency and independence [5], we as providers should utilize social media to reach and engage with Black athletes more effectively. The keys to orthopaedic knowledge cannot remain confined to ivory towers. Black athletes have a right to self-determination as it pertains to their most important asset: their health.

While online education is not a novel concept, the opportunity to provide targeted online content to the Black community remains largely untapped in orthopaedics. This is an opportunity that national orthopaedic leadership organizations should act upon. We need sports medicine education content to empower Black youth with the knowledge to ask the right questions when injuries occur and to inform decisions regarding return to play and rehabilitation—areas where Black athletes consistently fall behind other demographics [2]. I have personally tested samples of such social media content with local Black college athletes to incredibly positive response. In my experience, the most successful content engages the growing culture of athlete independence. There is a sense of liberation when one has the knowledge to discuss their health details with their providers.

But the reach of an individual provider like myself is limited. What would be more effective is a formal effort from the American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine to develop curricula and engaging content that can be distributed widely via social media platforms but specifically targeted to reach athletes of underserved communities.

Every young athlete should have access to basic knowledge of common sports injuries, the signs and symptoms of more serious injuries, as well as the keys to injury recovery and rehabilitation. Until we achieve a society where Black athletes are not at risk for having their injuries disregarded, we must ensure that they and their families are empowered with the knowledge to speak up when a sprain is not just a sprain.