ORIGINAL ARTICLE RMI study and clinical correlations of ankle retinacula damage and outcomes of ankle sprain Antonio Stecco • Carla Stecco • Veronica Macchi • Andrea Porzionato • Claudio Ferraro • Stefano Masiero • Raffaele De Caro Received: 22 September 2010 / Accepted: 14 January 2011 / Published online: 9 February 2011 Ó Springer-Verlag 2011 Abstract Recent studies reveal the role of the ankle reti- nacula in proprioception and functional stability of the ankle, but there is no clear evidence of their role in the outcomes of ankle sprain. 25 patients with outcomes of ankle sprain were evaluated by MRI to analyze possible damage to the ankle retinacula. Patients with damage were subdivided into two groups: group A comprised cases with ankle reti- nacula damage only, and group B those also with anterior talofibular ligament rupture or bone marrow edema. Both groups were examined by VAS, CRTA and static postur- ography and underwent three treatments of deep connective tissue massage (Fascial Manipulation technique). All eval- uations were repeated after the end of treatment and at 1, 3 and 6 months. At MRI, alteration of at least one of the ankle retinacula was evident in 21 subjects, and a further lesion was also identified in 7 subjects. After treatment, VAS and CRTA evaluations showed a statistically significant decrease in values with respect to those before treatment (p \ 0.0001). There were also significant improvements (p \ 0.05) in stabilometric platform results. No significant difference was found between groups A and B. The initial benefit was generally maintained at follow-up. The alter- ation of retinacula at MRI clearly corresponds to the pro- prioceptive damage revealed by static posturography and clinical examination. Treatment focused on the retinacula may improve clinical outcomes and stabilometric data. Keywords Ankle sprain Á Retinacula Á Proprioception Á Fascia Á Fascial manipulation Á Deep connective tissue massage Introduction Ankle sprain is one of the most common musculoskeletal injuries, representing 10–15% of all sports injuries. It is often considered a minor trauma but, according to many Authors [5, 6, 22, 41], 6–18 months after trauma, 72% of examined subjects still show recurring symptoms and repeated lateral ankle sprains [54]. Hubbard et al. [21] examining the causes of this clinical situation, called it chronic ankle instability (CAI), to highlight the fact that it derives from a combination of mechanical and functional variables. Their work also suggests that approximately 54% of the variance observed in patients with CAI remains unexplained, indicating that deeper knowledge of peripheral sensorimotor factors would contribute to better under- standing of complex ankle pathology. In particular, one element which has been neglected until now is the role played by ankle retinacula in proprioception and ankle biomechanics. In fact, according to Viladot et al. [51], Pisani [38] and Stecco et al. [49], the ankle retinacula cannot be considered merely as passive elements of stabilization, but as a sort of specialization of the fasciae to better perceive the movements of the foot and ankle as proprioceptive organs. There are no studies analyzing possible damage to these retinacula and their role in the outcomes of ankle sprain. For Platzer [39], Abu-Hijleh and Harris [1], Numkar- unarunrote et al. [35] and Benjamin [4], the retinacula are A. Stecco and C. Stecco contributed equally to this work. A. Stecco Á C. Ferraro Á S. Masiero Physical Medicine and Rehabilitation Clinic, University of Padova, Padua, Italy C. Stecco (&) Á V. Macchi Á A. Porzionato Á R. De Caro Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Via A. Gabelli 65, 35121 Padua, Italy e-mail: carla.stecco@unipd.it 123 Surg Radiol Anat (2011) 33:881–890 DOI 10.1007/s00276-011-0784-z