Biceps femoris long head muscle and aponeurosis geometry in males with and without a history of hamstring strain injury.

OBJECTIVES: Hamstring strain injuries (HSIs) commonly affect the proximal biceps femoris long head (BFlh) musculotendinous junction. Biomechanical modeling suggests narrow proximal BFlh aponeuroses and large muscle-to-aponeurosis width ratios increase localized tissue strains and presumably risk of HSI. This study aimed to determine if BFlh muscle and proximal aponeurosis geometry differed between limbs with and without a history of HSI. METHODS: Twenty-six recreationally active males with (n = 13) and without (n = 13) a history of unilateral HSI in the last 24 months underwent magnetic resonance imaging of both thighs. BFlh muscle and proximal aponeurosis cross-sectional areas, length, volume, and interface area between muscle and aponeurosis were extracted. Previously injured limbs were compared to uninjured contralateral and control limbs for discrete variables and ratios, and along the relative length of tissues using statistical parametric mapping. RESULTS: Previously injured limbs displayed significantly smaller muscle-to-aponeurosis volume ratios (p = 0.029, Wilcoxon effect size (ES) = 0.43) and larger proximal BFlh aponeurosis volumes (p = 0.019, ES = 0.46) than control limbs with no history of HSI. No significant differences were found between previously injured and uninjured contralateral limbs for any outcome measure (p = 0.216-1.000, ES = 0.01-0.36). CONCLUSIONS: Aponeurosis geometry differed between limbs with and without a history of HSI. The significantly larger BFlh proximal aponeuroses and smaller muscle-to-aponeurosis volume ratios in previously injured limbs could alter the strain experienced in muscle adjacent to the musculotendinous junction during active lengthening. Future research is required to determine if geometric differences influence the risk of re-injury and whether they can be altered via targeted training.

Diffusion tensor imaging of hamstring muscles after acute strain injury and throughout recovery in collegiate athletes.

OBJECTIVE: To identify the region of interest (ROI) to represent injury and observe between-limb diffusion tensor imaging (DTI) microstructural differences in muscle following hamstring strain injury. MATERIALS AND METHODS: Participants who sustained a hamstring strain injury prospectively underwent 3T-MRI of bilateral thighs using T1, T2, and diffusion-weighted imaging at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). ROIs were using the hyperintense region on a T2-weighted sequence: edema, focused edema, and primary muscle injured excluding edema (no edema). Linear mixed-effects models were used to compare diffusion parameters between ROIs and timepoints and limbs and timepoints. RESULTS: Twenty-four participants (29 injuries) were included. A significant ROI-by-timepoint interaction was detected for all diffusivity measures. The edema and focused edema ROIs demonstrated increased diffusion at TOI compared to RTS for all diffusivity measures (p-values < 0.006), except λ1 (p-values = 0.058-0.12), and compared to 12wks (p-values < 0.02). In the no edema ROI, differences in diffusivity measures were not observed (p-values > 0.82). At TOI, no edema ROI diffusivity measures were lower than the edema ROI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.69). A significant limb-by-timepoint interaction was detected for all diffusivity measures with increased diffusion in the involved limb at TOI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.42). Significant differences in fractional anisotropy over time or between limbs were not detected. CONCLUSION: Hyperintensity on T2-weighted imaging used to define the injured region holds promise in describing muscle microstructure following hamstring strain injury by demonstrating between-limb differences at TOI but not at follow-up timepoints.

Acute ankle injuries: association between sprain severity and ancillary findings.

Miranda et al. reported a correlation between the significance of injuries to osseous, chondral, tendon, and ligamentous tissues in participants with low-grade versus high-grade acute ankle sprains. They demonstrated that participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of structural abnormalities compared to those with low-grade sprains. Special attention should be paid to acute ankle sprains in emergency settings to avoid failure in detecting severe injuries that could lead to chronic pain, impairment, or instability. Participants presenting acute ankle sprains (<15 days) were divided into low-grade versus high-grade sprain,according to the presence of a complete tear in at least one component of lateral ligament complex. High-grade ankle sprains group presented increased rates of medial malleolus bone bruise, deltoid ligament tears,extensor retinaculum lesions, and articular effusion. The calcaneonavicular distance was statistically shorter in patients with high-grade sprains (median, 3.0mm) when compared to those with low-grade sprains (median, 4.0mm) Objective: To correlate the significance of osseous, chondral, tendon, and ligamentous injuries with anatomical variations in low-grade versus high-grade acute ankle sprains. METHODS: We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex. RESULTS: The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001). CONCLUSION: Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.

Chronic changes in muscle architecture and aponeurosis structure following calf muscle strain injuries.

BACKGROUND: Muscle strain injuries in the human calf muscles are frequent sports injuries with high recurrence. Potential structural and functional changes in the medial head of the musculus gastrocnemius (GM) and the associated aponeurosis are not well documented. PURPOSE: To test whether a GM muscle strain injury affects muscle fascicle length, pennation angle, and the morphology of the deep aponeurosis at rest and during muscle contraction long time after the injury. Additionally, electromyography (EMG) of the GM and the soleus muscle during a unilateral heel rise was measured in the injured and uninjured calf. METHODS: GM fascicle length, pennation angle, and aponeurosis thickness was analyzed on dynamic ultrasonography (US) recordings in 10 participants with a chronic calf strain. In addition, US images taken across the distal portion and mid-belly of the GM were analyzed at three different ankle positions. EMG recordings were obtained during a unilateral heel rise. RESULTS: The pennation angle of the injured distal GM was significantly larger compared to the uninjured GM in the contracted, but not the relaxed state. Pennation angle increased more in the injured compared to the uninjured GM during contraction. Fascicle length was shorter in the most distal portion of the injured GM. Fascicles at the distal portion of the injured GM showed a pronounced curvilinear shape as the muscle contracted and the aponeurosis was enlarged in the injured compared to the uninjured GM. The ratio between GM and soleus EMG activity showed a significantly higher relative soleus activity in the injured compared to the healthy calf. CONCLUSION: The greater change in pennation angle and curvilinear fascicle shape during contraction suggest that a long-term consequence after a muscle strain injury is that some muscle fibers at the distal GM are not actively engaged. The significantly enlarged aponeurosis indicates a substantial and long-lasting connective tissue involvement following strain injuries.

MRI in Acute Ankle Sprains: Should We Be More Aggressive with Indications?

Acute ankle sprains are common sports injuries. MRI is the most accurate test for assessing the integrity and severity of ligament injuries in acute ankle sprains. However, MRI may not detect syndesmotic and hindfoot instability, and many ankle sprains are treated conservatively, questioning the value of MRI. In our practice, MRI adds value in confirming the absence or presence of ankle sprain-associated hindfoot and midfoot injuries, especially when clinical examinations are challenging, radiographs are inconclusive, and subtle instability is suspected. This article reviews and illustrates the MRI appearances of the spectrum of ankle sprains and associated hindfoot and midfoot injuries.

Ankle Instability Update.

Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.

Don't Miss Me: Midfoot Sprains, A Point-of-Care Review.

Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.

Imaging of Acute Ankle and Foot Sprains.

Ankle and foot injuries are very common injuries in the general population, and more so in athletes. MR imaging is the optimal modality to evaluate for ligamentous injuries of the ankle and associated conditions after ankle sprain. In this article, the authors discuss the epidemiology, biomechanics, normal anatomy, and pathology of the ankle as well as injuries of the hindfoot and midfoot that are often associated with ankle injuries.

Is lateral ankle sprain of the child and adolescent a myth or a reality? A systematic review of the literature.

BACKGROUND: Ankle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions. METHODS: A systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis. RESULTS: SH1 fractures were found in 0-57.5% of the cases in all series and 0-3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2-80% and an osteochondral avulsion of the distal fibula in 6-28.1%. The most recent series report 76-80% and 62% for ATFL injury and osteochondral avulsion respectively. CONCLUSIONS: There is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities.

Structural connectome differences in pediatric mild traumatic brain and orthopedic injury.

Sophisticated network-based approaches such as structural connectomics may help to detect a biomarker of mild traumatic brain injury (mTBI) in children. This study compared the structural connectome of children with mTBI or mild orthopedic injury (OI) to that of typically developing (TD) children. Children aged 8-16.99 years with mTBI (n = 83) or OI (n = 37) were recruited from the emergency department and completed 3T diffusion MRI 2-20 days postinjury. TD children (n = 39) were recruited from the community and completed diffusion MRI. Graph theory metrics were calculated for the binarized average fractional anisotropy among 90 regions. Multivariable linear regression and linear mixed effects models were used to compare groups, with covariates age, hemisphere, and sex, correcting for multiple comparisons. The two injury groups did not differ on graph theory metrics, but both differed from TD children in global metrics (local network efficiency: TD > OI, mTBI, d = 0.49; clustering coefficient: TD < OI, mTBI, d = 0.49) and regional metrics for the fusiform gyrus (lower degree centrality and nodal efficiency: TD > OI, mTBI, d = 0.80 to 0.96; characteristic path length: TD < OI, mTBI, d = -0.75 to -0.90) and in the superior and middle orbital frontal gyrus, paracentral lobule, insula, and thalamus (clustering coefficient: TD > OI, mTBI, d = 0.66 to 0.68). Both mTBI and OI demonstrated reduced global and regional network efficiency and segregation as compared to TD children. Findings suggest a general effect of childhood injury that could reflect pre- and postinjury factors that can alter brain structure. An OI group provides a more conservative comparison group than TD children for structural neuroimaging research in pediatric mTBI.

Hamstring and gluteal activation during high-speed overground running: Impact of prior strain injury.

This study examined the spatial patterns of hamstring and gluteal muscle activation during high-speed overground running in limbs with and without aprior hamstring strain injury. Ten active males with arecent (<18 month) unilateral biceps femoris long head (BFLH) strain injury underwent functional magnetic resonance imaging before and immediately after arepeat-sprint running protocol. Transverse relaxation (T2) time, an index of muscle activation, of the BFLH and short head (BFSH), semitendinosus (ST), semimembranosus (SM), gluteus maximus (GMAX) and medius (GMED) was assessed pre-post exercise. No significant between-limb differences in running-induced mean T2 changes were observed (p = 0.949), however, decision tree induction revealed that previously injured limbs were characterised by highly variable intramuscular activation of the ST (SD5.3). T2 times increased more for GMAX than all other muscles (all p< 0.001, d= 0.5-2.5). Further, T2 changes were greater for ST than BFSH, SM, GMED, and BFLH (all p≤ 0.001, d= 0.5-2.9); and were greater for BFLH than BFSH, SM, and GMED (all p< 0.001, d= 1.2-1.6). Athletes display heterogenous patterns of posterior thigh activation when sprinting (GMAX>ST>BFLH>GMED>SM>BFSH) and may exhibit altered intramuscular hamstring activation after returning to sport from BFLH strain injury.

Acute Talar Cartilage Deformation in Those with and without Chronic Ankle Instability.

PURPOSE: This study aimed 1) to determine whether talar cartilage deformation measured via ultrasonography (US) after standing and hopping loading protocols differs between chronic ankle instability (CAI) patients and healthy controls and 2) to determine whether the US measurement of cartilage deformation reflects viscoelasticity between standing and hopping protocols. METHODS: A total of 30 CAI and 30 controls participated. After a 60-min off-loading period, US images of the talar cartilage were acquired before and after static (2-min single-leg standing) and dynamic (60 single-leg forward hops) loading conditions. We calculated cartilage deformation by assessing the change in average thickness (mm) for overall, medial, and lateral talar cartilage. The independent variables include time (Pre60 and postloading), condition (standing and dynamic loading), and group (CAI and control). A three-way mixed-model repeated-measures ANCOVA and appropriate post hoc tests were used to compare cartilage deformation between the groups after static and dynamic loading. RESULTS: After the static loading condition, those with CAI had greater talar cartilage deformation compared with healthy individuals for overall (-10.87% vs -6.84%, P = 0.032) and medial (-12.98% vs -5.80%, P = 0.006) talar cartilage. Similarly, the CAI group had greater deformation relative to the control group for overall (-8.59% vs -3.46%, P = 0.038) and medial (-8.51% vs -3.31%, P = 0.043) talar cartilage after the dynamic loading condition. In the combined cohort, cartilage deformation was greater after static loading compared with dynamic in overall (-8.85% vs -6.03%, P = 0.003), medial (-9.38% vs -5.91%, P = 0.043), and lateral (-7.90% vs -5.65%, P = 0.009) cartilage. CONCLUSION: US is capable of detecting differences in cartilage deformation between those with CAI and uninjured controls after standardized physiologic loads. Across both groups, our results demonstrate that static loading results in greater cartilage deformation compared with dynamic loading.

Site-specific features of active muscle stiffness and proximal aponeurosis strain in biceps femoris long head.

Limited information is available on site-specific features of muscle stiffness and aponeurosis strain of the biceps femoris long head (BFlh) during contractions. Therefore, understanding of the mechanics and etiology of hamstring strain injuries remains difficult. As a first step to gain further insight into them, the present study aimed to identify whether active muscle stiffness and proximal aponeurosis strain during contractions are varied along the long axis of the BFlh. The BFlh muscle shear wave speed (proxy for stiffness) was measured in the proximal, central, and distal sites during 20%, 50%, and 80% of maximal voluntary isometric contraction (MVC) of knee flexion exerted with the hip and knee joints flexed at 40° and 30°, respectively, using ultrasound shear wave elastography. Further, a segmental strain of the BFlh proximal aponeurosis was assessed in the proximal, central, and distal sites during isometric knee flexion, using B-mode ultrasonography. The shear wave speed was significantly higher in the distal site than the proximal and central sites at 20% MVC (p ≤ .002, with a large effect size), whereas no significant difference was found between the three sites at 50% and 80% MVC. The BFlh proximal aponeurosis strain showed no significant difference between the proximal, central, and distal sites at any contraction intensity. These findings indicate that site-specific differences in muscle stiffness and proximal aponeurosis strain are substantially small and that muscle stiffness and proximal aponeurosis strain of the BFlh at moderate-to-high contraction intensity is not exceptional in the site where a sprinting-type hamstring strain typically occurs.

Prevention of strain-induced impairments of patellar tendon micromorphology in adolescent athletes.

High-level patellar tendon strain may cause impairments of the tendon's micromorphological integrity in growing athletes and increase the risk for tendinopathy. This study investigated if an evidence-based tendon exercise intervention prevents high-level patellar tendon strain, impairments of micromorphology and pain in adolescent basketball players (male, 13-15 years). At three time points over a season (M1-3), tendon mechanical properties were measured using ultrasound and dynamometry, proximal tendon micromorphology with a spatial frequency analysis and pain and disability using VISA-P scores. The control group (CON, n = 19) followed the usual strength training plan, including sprint and change-of-direction drills. In the intervention group (INT, n = 14), three sessions per week with functional exercises were integrated into the training, providing repetitive high-magnitude tendon loading for at least 3 s per repetition. The frequency of high-level strain (ie, ≥9%) continuously decreased in INT, while tending to increase in CON since tendon force increased in both (p < 0.001), yet tendon stiffness only in INT (p = 0.004). In CON, tendon strain was inversely associated with tendon peak spatial frequency at all time points (p < 0.05), indicating impairments of tendon micromorphological integrity with higher strain, but not at M2 and M3 in INT. Descriptively, the fraction of asymptomatic athletes at baseline was similar in both groups (~70%) and increased to 100% in M3 in INT, while remaining unchanged in CON. We suggest that functional high-load tendon exercises could reduce the prevalence of high-level patellar tendon strain and associated impairments of its micromorphology in adolescent athletes, providing new opportunities for tendinopathy prevention.

The LISFRANC JUT: A physical finding of subtle LISFRANC injuries.

INTRODUCTION: Low-energy Lisfranc injuries are uncommon and are often misdiagnosed as sprains. This results in a delay for the definitive treatment. The aim of this study is to discuss the physical finding of a midfoot "jut," that can be used to help diagnose subtle Lisfranc injuries, in patients who present with persistent midfoot pain after low-energy trauma. PATIENTS AND METHODS: Between January 2015 through December 2019, patients previously diagnosed with a sprain, who were at least six weeks after their original injury, and presented with midfoot pain, were identified. All had a bony prominence on the medial border of the first tarsometatarsal joint, defined as a "jut", which produced pain. Standing radiographs demonstrated subluxation of the tarsometatarsal joint(s). RESULTS: Seven patients (5 females/2 males) presented as isolated injuries, with a mean age of 40.4 years. Mechanisms of injury were five falls, one from a sporting event, and one twisting injury. Time to diagnosis, from their date of injury, averaged 9.9 weeks. All underwent fixation. Follow-up averaged 13.7 months. At final follow-up none of the patients developed surgical site infections, wound dehiscence, loosening of implants, loss of reductions or a recurrence of the "jut". None of the patients demonstrated arthrosis and only one patient had a broken screw and declined further surgical intervention. DISCUSSION AND CONCLUSIONS: Patients presenting with a history of low-energy trauma, a diagnosis of sprain, continued complaint of foot pain, and a "jut" on the medial border of the midfoot, should be evaluated for a subtle Lisfranc injury.

Magnetic resonance imaging of midtarsal sprain: Prevalence and impact on the time of return to play in professional soccer players.

BACKGROUND: Ankle sprain is a common injury in professional soccer, but to date midtarsal sprain has not been investigated in this context. The purpose of this study was to determine the prevalence of midtarsal sprain by MRI and to assess its impact on the time of return to play in professional soccer players. METHODS: We included 52 professional soccer players who underwent 59 MRI examinations after acute ankle trauma between January 2012 and September 2019. Images were retrospectively reviewed in consensus by two radiologists for assessment of midtarsal sprain and ankle sprain. Ligaments were graded as i) normal, ii) partial tear, or iii) complete tear. Time to return to play (RTP) for each athlete was retrieved from team medical records. A Kruskal-Wallis test and Dunn's pairwise tests were used to calculate differences in RTP time between groups with i) isolated midtarsal sprain, ii) isolated lateral ankle sprain, and iii) combined midtarsal and lateral ankle sprain. RESULTS: MRI revealed isolated ankle sprain in 24 of 59 MRI examinations (40.6 %). Acute midtarsal ligament injury was present in 15 examinations (25.4 %). Four of the 15 examinations (26.7 %) had isolated midtarsal injuries and eleven of the 15 examinations (73.3 %) had concomitant ankle sprain. RTP time was 39 days (range 9-70 days) for isolated midtarsal sprain. RTP time was significantly higher for athletes with combined ankle and midtarsal sprain (47 days, range 15-74 days) when compared to athletes with isolated ankle sprain (24 days, range 2-59 days) (p = .019). CONCLUSION: Our MRI study reveals that midtarsal sprain is a frequent injury in professional soccer players with ankle sprain. Midtarsal ligament findings on MRI combined with evidence of lateral ankle sprain is associated with a longer time of return to play compared to isolated lateral ligament injuries. LEVEL OF EVIDENCE: Retrospective study, observational study.

Associations between clinical findings and MRI injury extent in male athletes with acute adductor injuries - A cross-sectional study.

OBJECTIVES: To investigate the association between clinical assessment and MRI measures of oedema and MRI grading in male athletes with acute adductor injuries. DESIGN: Cross-sectional study. METHODS: We included 81 consecutive athletes with acute adductor injuries. All athletes received a standardized clinical assessment and magnetic resonance imaging (MRI), blinded to clinical information. We analysed correlations between extent of palpation pain and extent of MRI oedema for the adductor longus. We compared the clinical assessment to MRI adductor injury grading (0-3) using ordinal regression. We analysed positive and negative predictive values (PPV/NPV) of a complete adductor longus avulsion. RESULTS: Proximal-distal length of adductor longus palpation pain had fair correlation with MRI proximal-distal oedema length oedema (r=0.309, p=0.022). Cross-sectional surface area of palpation pain had poor correlation with corresponding cross-sectional MRI oedema area (r=0.173, p=0.208). The symptoms subscale of the Copenhagen Hip And Groin Outcome Score (HAGOS) for the period since injury (log odds ratio=0.97, p=0.021) and passive adductor stretch pain (log odds ratio=0.35, p=0.046) were associated with MRI injury grading. If there was a palpable defect, MRI always showed a complete avulsion (PPV=100%). Several tests had high negative predictive values: passive adductor stretch (100%), palpation pain at the adductor longus insertion (98%), and the FABER test (98%). CONCLUSIONS: The extent of palpation pain does not indicate the extent of MRI oedema in acute adductor longus injuries. A worse modified HAGOS symptoms subscale score and passive adductor stretch pain indicate a higher MRI adductor injury grade. Clinical examination tests have high ability to detect or rule out a complete adductor longus avulsion on MRI.

An Overlooked Cause of Posterior Knee Pain: Ultrasound Imaging and Guided Injection for Proximal Lateral Gastrocnemius Tendon Sprain.

Proximal lateral gastrocnemius tendon injury is an overlooked cause of posterior knee pain. As the proximal gastrocnemius tendon attaches on the distal femur; its pain is more deeply located and can also be aggravated by flexion of the affected knee. In the present report, sonopalpation showed that the painful tendon appeared to have lost its fibrillary pattern and become thickened and hypoechoic as well. Under the diagnosis of proximal gastrocnemius tendon sprain, the ultrasound guided dextrose injection was performed and the pain was totally relieved.

Ultrasonography Comparison of the Plantar Fascia and Tibialis Anterior in People With and Without Lateral Ankle Sprain: A Case-Control Study.

OBJECTIVE: The purpose of the present study was to evaluate the thickness of the plantar fascia (PF) at the insertion of the calcaneus and the midfoot and forefoot fascial locations, in addition to the thickness of the tibialis anterior, by ultrasound imaging in individuals with and without lateral ankle sprain (LAS). METHODS: A sample of 44 participants was recruited and divided in 2 groups: 22 feet with a prior diagnosis of grade 1 or 2 LAS (case group) and 22 feet without this condition (healthy group). The thickness and cross-sectional area were evaluated by ultrasound imaging in both groups. RESULTS: Ultrasound measurements of the PF at the calcaneus, midfoot, and forefoot showed statistically significant differences (P < .05), with a decrease in thickness in the LAS group relative to the healthy group. For the thickness and cross-sectional area of the tibialis anterior, no significant differences (P < .05) were observed between groups. CONCLUSION: The thickness of the PF at the calcaneus, midfoot, and forefoot is reduced in individuals with LAS relative to the healthy group.