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LEVEL OF EVIDENCE: 4 SUMMARY Background. The retinacula are important dynamic stabilizers around the ankle joint and are susceptible to potential injury in high-level footballers. Aim. The purpose of this study was to evaluate the prevalence of retinacula injury in asymptomatic professional football players and for the presence of associated ankle tendon or ligament abnormalities. Methods. Seventeen professional football players from one English premier league club underwent ultrasound examination of both ankles. The retinacula around the ankle were measured for thickness and compared with normal values. Ankle tendons were evaluated for the presence of abnormal vascularity or tendinopathy, tendon sheath effusions, and for peroneal tendon subluxation. Lateral ankle ligaments were also examined. Results. The results indicated increased thickness of the retinacula at the following sites: superior extensor retinaculum on the medial side(1.5 mm, normal 0.9 mm) ; superior peroneal retinaculum at the anterior insertion (2.16 mm, normal 1 mm); and flexor retinaculum at the anterior insertion into the tibia (1.78 mm, normal.0.9 mm). Fluid around the tibialis posterior tendon was a frequent finding representing 74%, whilst over 25% revealed fluid within the peroneal tendon sheaths. Over 50% of the scans revealed thickened and abnormal lateral ligament complexes. Conclusions. The thickening of the retinacula may indicate scarring from previous injury or repetitive micro-trauma, attributable to the ball kicking biomechanics, kinematics and contact injuries during tackles. Furthermore tendon sheath fluid was commonly seen on both the medial and lateral side of the ankle. We conclude that chronic scarring and thickening of these structures should be recognized as a common and often incidental finding and the significance in asymptomatic professional footballers is minimal.

Asymptomatic Professional Footballers: Prevalence of Ankle Retinacula Injury with Associated Lateral Ligament and Tendon Abnormalities