Anterior cruciate ligament tears are common and affect young individuals who participate in jumping and pivoting sports. After injury many individuals undergo ligament reconstruction (ACLR) but do not return to play, suffer recurrent injury and osteoarthritis. Outcome studies show that after ACLR, 81% of individuals return to sports, 65% return to their preinjury level and 55% return to competitive sports. Systematic reviews place the risk of ipsilateral retears at 5.8% and contralateral injuries at 11.8%, with recent reports of over 20% failure rate. Approximately 20% to 50% of patients will have evidence of OA within 10 to 20 yr. Factors important in reducing complications include timing of surgery, individualized return to play protocols, and prevention programs for injury. Further understanding of the factors that increase return to play percentages, reduce the risk of recurrent injury and improve long-term outcomes after ACL injury is needed to reduce the burden of these injuries on society.

Dental services in sports competitions in the Games sponsored by the International Olympic Committee are mandatory. In every Central American, Pan American and Olympic Summer Games, as well as Winter Games, the Organizing Committee has to take all the necessary measures to assure dental services to all competitors. In all Olympic villages, as part of the medical services, a dental clinic is set up to treat any dental emergency that may arise during the Games. Almost every participating country in the Games has its own medical team and some may include a dentist. The major responsibilities of the team dentist as a member of the national sports delegation include: (i) education of the sports delegation about different oral and dental diseases and the illustration of possible problems that athletes or other personnel may encounter during the Games, (ii) adequate training and management of orofacial trauma during the competition, (iii) knowledge about the rules and regulations of the specific sport that the dentist is working, (iv) understanding of the anti-doping control regulations and procedures, (v) necessary skills to fabricate a custom-made and properly fitted mouth guard to all participants in contact or collision sports of the delegation. This study illustrates the dental services and occurrence of orofacial injury at the Central American and Caribbean Sports Games of the Puerto Rican Delegation for the past 20 years. A total of 2107 participants made up the six different delegations at these Games. Of these 279 or 13.2% were seen for different dental conditions. The incidence of acute or emergency orofacial conditions was 18 cases or 6% of the total participants. The most frequent injury was lip contusion with four cases and the sport that experienced more injuries was basketball with three cases.

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Avulsion of the flexor digitorum profundus tendon insertion has been reported several times,'-' and is being more frequently recognized as an athletic injury.4-6 Simultaneous avulsion of both flexor tendons, however, is quite rare and has not previously been reported in an athlete. Of the 80 flexor tendon ruptures reported by Boyes et al,' 8 cases involved both flexor tendons at their insertions. Two avulsions were caused by crushing or lacerations and a third was caused by disease. Four others were due to hyperextension injuries and one to forced flexion. No other reports of avulsion of both flexor tendons in a single finger could be found. CASE REPORTWhile attempting to make a tackle, a 16-year-old high school football player grabbed the ball carrier's jersey with his Figure 1. Resting posture of the hand prior to surgery.There is full extension of both interphalangeal joints of the ring finger, while the joints of the other fingers are mildly flexed. nondominant left hand. As the runner pulled away from his grasp, the patient felt a sudden pain shooting along the ring finger and palm. He then noted inability to flex the ring finger. The astute team physician immediately recognized the injury as an unusual one, because the patient was unable to flex either the proximal or distal interphalangeal joints, and referred him to us for care.The finger was fully extended at both interphalangeal joints ( Fig. 1) when examined in the resting posture. There was no active flexion, although full passive flexion at both Figure 2. Avulsed profundus tendon at the level of the proximal interphalangeal joint. The avulsed superficialis tendon in the distal palm. tAddress correspondence to James E. Culver, M D , 9500 Euclid Ave , Cleveland, OH 44106 ,¡

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