Level IV-retrospective case series.

Background-Magnetic resonance imaging (MRI) produces exceptionally detailed images of the intra-articular structures of the knee. Recognising the range of MRI appearances within a normal population is therefore necessary in order to avoid attributing a greater significance to these than is clinically justified. Objective-To compare MRI appearances in asymptomatic gymnasts with those in a less active population in order to identify findings that may be seen in the absence of significant pathology and thereby aid the clinical management of this athletic group. Methods-MR images were obtained from 24 knees of asymptomatic competitive American collegiate gymnasts aged 18-22. The menisci were evaluated according to established grading criteria, and compared with a group of controls matched for age and sex. Results-Grade 3 intrameniscal signal abnormalities are considered to be highly correlated with meniscal tears. When compared with control group, the experimental group of gymnasts had a significantly diVerent distribution (p<0.001) of grade 3 intrameniscal signal changes, preferentially involving the lateral meniscus. The overall incidence of grade 3 changes (13%) in gymnasts was not, however, significantly diVerent from the incidence in the controls. Conclusions-A knowledge of these MRI appearances is important when evaluating the lateral menisci within this group of athletes to prevent unnecessary treatment or intervention. This is particularly pertinent when the imaging findings do not closely correlate with the site of symptoms. (Br J Sports Med 1999;33:414-416)

This case presents an athletic 40-year-old female marathon runner who presented with a headache secondary to dural venous sinus thrombosis and right calf deep vein thrombosis (DVT). Though this is outside of the typical image we portray of a common DVT patient, athletes too experience hypercoagulable risk factors and medical issues, just as their less in-shape peers. This patient's history of oral contraceptive use, Lynch syndrome, colon cancer, and pregnancy indicates potential risk factors for DVT. Even without these though, it is important to note that every endurance athlete experiences hemoconcentration, dehydration, and inflammation during exercise, training, and competition events. This case demonstrates the need for an increased index of suspicion in endurance athletes. The case exemplifies an all-too-frequent occurrence of allowing our differential to be skewed away from potentially life-threatening conditions like DVT, and their thrombotic sequelae, because of the "textbook population" descriptions of a given disease state. We hope this case will shed needed light on the phenomenon and lead to more controlled research on the probability and pathophysiology for thrombotic events in this broadened population so that its incidence and prevalence in endurance athletes can be accurately reported in the literature.