Lyme Disease in a Young Girl.

In brief: An 11 1/2-year-old girl had a seven-month history of bilateral knee pain and swelling; her x-rays and bone scan were normal. She had been treated unsuccessfully with rest and physical therapy before being referred to a sports medicine clinic. Laboratory studies demonstrated a positive titer for Lyme disease. She was treated with tetracycline and had an uneventful recovery.

The Prairie State Games: Organization of Medical Care.

In brief: The finals of the Prairie State Games, an Olympic-style sports festival, annually attract nearly 3,000 Illinois amateur athletes, who sustain an average of 265 injuries per year. Although most of the injuries are orthopedic, a moderate number of heat-related problems occur. Most injuries are associated with soccer, wrestling, and basketball. A medical director who is a physician coordinates the efforts of the more than 30 volunteer physicians and 60 athletic trainers who constitute the medical corps. This article describes the guidelines for providing medical care at this large-scale athletic event.

Internal derangement of the knee: diagnosis by arthrography, arthroscopy, and arthrotomy.

Three hundred eighty-four cases involving all patients with meniscal or anterior cruciate ligament tears were examined surgically by 16 orthopedic surgeons over two distinct 12-month periods. The incidence of both menisci (ipsilateral knee) torn was 3.9%, and the ratio of medial to lateral meniscal tears was 2.7:1. Twelve percent of cases had tears of the anterior cruciate ligament, 70% of which were found with a concomitant medial meniscus tear. Arthrography was completely accurate in 73.2% of cases, and arthroscopy was accurate in 94.9%. When clinical impression, arthrography, and arthroscopy were combined, the overall diagnostic accuracy was 96.8%.

Scintigraphic localization of bone lesions during surgery.

Nuclear medicine provides several methods for increasing the accuracy of surgical removal of bone lesions with focally increased uptake. In this paper, three intraoperative procedures are discussed: remote control by imaging, intraoperative control by imaging, and intraoperative control by scintillation probe. All techniques require preoperative injection of bone imaging tracer. Remote operative control calls for a gamma camera to mark the skin over the lesion prior to surgery, providing optimal preoperative localization and imaging of the excised lesion to ensure complete removal. Intraoperative control procedures require that a portable camera or a scintillation probe be used in the operating room; these permit direct monitoring of localization and resection. Our experience with 18 procedures performed on 15 patients suggests that these techniques are worthy of continued use.

Distance Race Injuries: An Analysis of Runners' Perceptions.

In brief: This report examines the type and frequency of self-reported injuries that occurred at the Chicago Distance Classic, a 20km race held each year in July. Questionnaires were sent to the nearly 5,000 entrants. The runners were asked about their medical history and if they had suffered injuries or illnesses from the race. Most entrants had been running two to five years. More than half stretched regularly before and after running. The knee was most often injured (10%), and the foot was second. Most orthopedic, knee, and foot injuries occurred to beginners, and most entrants were between ages 31 and 40. Many of the entrants said they were affected by the heat; 31 said they suffered severely from the heat.

A comparison of men's and women's professional basketball injuries.

Injuries sustained by male and female professional basketball teams were compared. Injuries from two consecutive seasons were coded, and computer-based cross-tabulations comparing sex, body part, and type of injury were performed. The women's injury frequency was 1.6 times that of men. The body part most frequently injured on both teams was the ankle. Women sustained significantly more knee and thigh injuries as well as sprains, strains, and contusions. Men had significantly more muscle spasms. Other injuries occurred in similar patterns in both sexes. Alterations in training programs are suggested with emphasis on women's strengthening and men's flexibility.

Incomplete tears of the anterior cruciate ligament and knee locking.

An infrequently considered cause of knee locking in incomplete tear of the anterior cruciate ligament. In this series, 19 locked knees were diagnosed at the time of arthrotomy as isolated incomplete tears of the anterior cruciate ligament. No pathological findings associated with the menisci, patella, or collateral ligaments were evident. In each case, the torn portion of the anterior cruciate ligament was demonstrated to be the mechanism for locking, and locking resolved with excision or repair of the torn portion.

The Thompson Test for Ruptured Achilles Tendon.

Active plantar flexion at the ankle does not rule out an Achilles tendon rupture. The authors review an easy way to diagnose this injury promptly.

Medical Aspects of Distance Race Planning.

Physicians should help set the standards for medical care at long-distance races. The authors recommend that runners be educated, and they set guidelines for aid stations and paramedical personnel.