Mixed martial arts (MMA) occupies a uniquely precarious position in the field of contemporary performance sport. Featuring the striking of downed opponents, a relatively high frequency of blood-letting, and a promotional culture which creates and amplifies narratives of hostility between performers, the sport’s legitimacy is often questioned as it is seen to blur the lines between combat sport and violence. In this context, serious injuries and deaths related to sporting competition – although rare – take on added meaning compared to their appearance in other sports, due to the symbolic importance these have for the public discourse on the moral propriety of MMA. Based on over 200 hours of fieldwork observations at competitive events, and interviews with 25 medical personnel as well as 7 referees and 9 promotion staff in the United Kingdom, I argue that the provision of medical care is seen by many in the field as a means of protecting the threatened reputation of the sport, as well as the reputations of those who work within it. I evaluate the implications this has for the types of care that athletes might expect to receive at different levels of competition, and in comparison with related combat sports.