Survey of Orthopaedic and Sports Medicine Physicians Regarding Use of Medrol Dosepak for Sports Injuries Phillip Langer, M.D., Paul Fadale, M.D., Michael Hulstyn, M.D., Braden Fleming, Ph.D., and Mark Brady, B.S. Purpose: To study the use of a methylprednisolone taper (Medrol Dosepak; Pfizer, New York, NY) short-term oral corticosteroid treatment modality by sports medicine physicians; included is discussion on indications, perceived efficacy, and complications. Methods: A survey specific to Medrol Dosepak (MDP) use was mailed to all members of the Arthroscopy Association of North America (AANA) and the American Orthopedic Society for Sports Medicine (AOSSM). Surveys were collected and data were collated and analyzed. Results: Total response rate was 41% (1,290/3,167), US response rate 43% (1,247/2,906), and international response rate 16% (43/261). Prescribing of MDP for sports injuries was significantly associated with average patient age 40 years ( square; P = .001), but it was not associated with years in practice or patients seen per year. It was found that 47% of members (603/1,290) prescribe MDP. Postinjury disease was the most common indication. The most frequent complication was glucose intolerance (37%; 222/603). Of members who prescribe MDP, 8.5% (51/603) reported that they had seen 101 total cases of osteonecrosis, predominantly in the hip. Results revealed that 52% of members (672/1,290) do not prescribe MDP. The most frequent reasons for not prescribing included fear of osteonecrosis (30%; 201/672), fear of complications in general (27%; 183/672), lack of proven efficacy (27%; 180/672), and fear of malpractice (4.5%; 30/672). Of nonprescribing members (171/672), 25% had seen 500 cases of osteonecrosis, most often in the hip. Conclusions: The responding membership of AANA and AOSSM is evenly split regarding MDP use. Average patient age 40 years was associated with a greater likelihood that MDP would be prescribed for sports injuries. Postinjury disease is the most common indication; lack of proven efficacy and osteonecrosis are deterrents to prescription. Level of Evidence: Level V, expert opinion. Key Words: Sports injuries—Methylprednisolone—Oral corticosteroids. T he routine use of anti-inflammatory medica- tions, including corticosteroids, for the treat- ment of patients with athletic injuries is controver- sial. Anti-inflammatory medications have gained widespread acceptance by athletes, athletic trainers, and physicians as a treatment adjunct during reha- bilitation for sports-related musculoskeletal prob- lems. Although these medications effectively re- duce inflammation and pain, concern has been expressed about the scarcity of published clinical trials, unclear indications, potentially serious ad- verse effects, and even inhibition or delay of normal healing after injury. 1-4 Corticosteroids, the most potent inhibitors of inflammation, have been partic- ularly scrutinized because of untoward effects that have been documented with long-term high-dose systemic use. Reports on adverse effects associated with low-dose corticosteroid use have shown that few commonly held beliefs about their incidence are supported by clear evidence. 5 Nichols 6 searched medical literature that described the risks and complications associated with corticoste- From the Department of Orthopedic Surgery, Brown University Medical School, Providence, Rhode Island, U.S.A. Supported by outside funding or grants from University Ortho- pedics, Inc., and Rhode Island Orthopaedic Foundation. The authors report no conflict of interest. Address correspondence and reprint requests to Phillip Langer, M.D., Department of Orthopedic Surgery, Brown Medical School/ Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, U.S.A. E-mail: langerpr@hotmail.com © 2006 by the Arthroscopy Association of North America 0749-8063/06/2212-0684$32.00/0 doi:10.1016/j.arthro.2006.08.020 Note: To access the supplementary table and figure accompa- nying this report, visit the December issue of Arthroscopy at www.arthroscopyjournal.org. 1263 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 22, No 12 (December), 2006: pp 1263-1269