The 2011 sports health sisk awards.

T. David Sisk, MD, left this world on July 9, 2009, but his memory certainly lives on. His clinical expertise, tireless commitment to sports medicine care for the athlete, career-long support of the American Orthopaedic Society for Sports Medicine (AOSSM), and leadership of the AOSSM Medical Publishing Board of Trustees are but a few of his gifts to his colleagues and friends. From his very humble origins and meager resources in rural Tennessee, he excelled athletically and scholastically in high school and college. A knee injury altered his athletic pursuits and influenced his career choice of medicine and, eventually, orthopaedics. He dedicated his career to the Campbell Clinic and to Memphis athletes. In his latter days as chairman of the AOSSM Medical Publishing Board of Trustees, he rigorously supported the development of this journal, Sports Health: A Multidisciplinary Approach. In 2011, the Sisk Awards were established in Dr Sisk’s memory to annually recognize the best contributions to Sports Health in basic science and clinical research.

The Editorial Team of Sports Health, including representatives from the National Athletic Trainers’ Association, Sports Physical Therapy Section, and American Medical Society for Sports Medicine, recently met to decide the winners of the inaugural Sisk Awards. The 2011 Sisk Award for the Best Clinical Research Paper was given to Jeffery S. Kutcher, MD, for his article “Management of the Complicated Sports Concussion Patient.”[4] The 2011 Sisk Award for the Best Basic Science Paper was given to Alice J. Sophia Fox, MSc, Asheesh Bedi, MD, and Scott A. Rodeo, MD, for their article “The Basic Science of Articular Cartilage: Structure, Composition, and Function.”[2]

The work by Dr Kutcher is a primer in concussion care. Because of the high frequency of concussion, its management is of great concern to the sports medicine clinician. While 80% to 90% of sports-related concussions resolve in 7 to 10 days, some do not and require special attention in their evaluation and management.[5] Unfortunately, most of us are aware of the feared neurodegenerative conditions that have been reported in autopsies in former National Football League players and boxers. Until clinical studies can predict who is at risk for these dreaded outcomes, we should take great care in the management of all concussions. Dr Kutcher’s work clearly identifies the situations during which we should be on high alert. After a concussion has occurred, if the athlete is resting both physically and mentally, symptoms should improve. Worsening symptoms after a period of improvement is an ominous signal for caution. For example, a seizure occurring during a concussion event is not nearly as worrisome as one that occurs hours after the event.

The clinical dilemma of repeat concussions is addressed, emphasizing the fact that the threshold for concussion may decrease with each concussive episode. High school football players who suffer a concussion are 3 times more likely to experience another concussion in the same season,[3] while those that lost consciousness are 6 times more likely to sustain another concussion than those who did not lose consciousness.[1]

The all-too-common, worrisome scenario of prolonged symptoms after a concussion is addressed by Dr Kutcher with the emphasis on distinguishing primary versus secondary mechanisms. Primary mechanisms may just require more time to recover, while secondary mechanisms may require treatment before clinical improvement is seen. Clearly, comorbid conditions, such as migraine headaches and depression, can delay and complicate the recovery for the athlete.

Last, and most important, Dr Kutcher provides guidelines for the most difficult decision for most—namely, who should consider retirement from contact sports. Nobody relishes the opportunity to suggest to an athlete that his or her career should end, while bringing an end to an athlete’s career prematurely and unnecessarily is almost as disconcerting. These can be very difficult decisions, so guidelines are very helpful especially when there are clear hallmarks for decision making. For instance, when there is substantial symptom burden, when decreasing force is needed to concuss, or when an athlete does not return to baseline in cognition or personality after a concussion, a stoppage of contact sports is warranted. Dr Kutcher’s article provides a very practical guideline that is a great resource for clinicians, athletes and their families, and coaches faced with concussion decision making.

On the basic science side, the articular cartilage review by Fox et al is a concise overview of its structure, composition, and function. Few areas in orthopaedics are subject to more research than articular cartilage today. With degenerative arthritis being the number one disability in the United States, these research efforts are certainly justified. As clinicians struggle to deal with joint degeneration, a solid understanding of the uniqueness and complexity of articular cartilage is invaluable. While articular cartilage salvage and resurfacing procedures develop and advance, an understanding of the basics of normal articular cartilage function is needed by clinicians to judge the value and role of these treatment options. Some new methods will be excellent technological advances with little clinical utility. Other methods will represent real clinical advances of great value to patients. The work by Fox et al provides the clinician with the understanding to distinguish between the two and make good clinical choices, and also provides the details for the best methods for imaging outcomes.

Both of the 2011 Sisk Award–winning papers are well-written, concise overviews of timely topics in sports medicine: concussion and articular cartilage. Both papers accurately summarize volumes of research, delivering to the clinician a guideline and an understanding of clinical problems that are critically important to our patients. I congratulate these authors on a job well done!

The Editorial Team for Sports Health looks forward to the journal submissions for this next year in anticipation of next year’s Sisk Awards (deadline May 1, 2012).