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Plantaris tendon tear

The classic clinical manifestation is in a middle-aged person who complains of sport-related acute pain in the middle portion of the calf, associated with a snapping sensation ("tennis leg").
MR imaging findings of the plantaris tendon tear include the following:
- abnormally increased signal intensity in the injured plantaris muscle or myotendinous junction on T2-weighted images,
- fluid collections between the medial head of the gastrocnemius and soleus muscle,
- associated partial tear of the lateral head of the gastrocnemius muscle,
- myotendinous rupture with proximal retraction of the muscle and masslike appearance between the popliteus tendon and lateral head of the gastrocnemius,
- associated tears of the anterior cruciate ligament and arcuate complex, and
- bone contusions in the lateral compartment.

Ax Pd T2 Fat Sat
Ax Pd T2 Fat Sat

Ax T1
Ax T1

42 yo M with calf pain and swelling

The plantaris originates from the lateral supracondylar line just above the attachment of the lateral head of the gastrocnemius. Its slender muscle belly, which is approximately 2-4 inches (5-10 cm) long, lies deep to the lateral head of the gastrocnemius. The thin and long plantaris tendon crosses down between the medial head of the gastrocnemius and soleus muscles. It inserts on the calcaneus anteromedial to the Achilles tendon or directly into the Achilles tendon. The plantaris is absent in 7%-10% of the population.
Forceful contraction of the plantaris muscle may result in rupture. The classic clinical manifestation is in a middle-aged person who complains of sport-related acute pain in the middle portion of the calf, associated with a snapping sensation ("tennis leg"). Plantaris muscle strains have been noted in association with traumatic tears of the anterior cruciate ligament, arcuate ligament complex, and posterolateral corner muscles (lateral head of the gastrocnemius and popliteus). A posterior compartment syndrome, which requires surgical decompression, is a potential complication of plantaris or medial gastrocnemius ruptures.

MR imaging findings of the plantaris tendon tear include the following:

- abnormally increased signal intensity in the injured plantaris muscle or myotendinous junction on T2-weighted images,
- fluid collections between the medial head of the gastrocnemius and soleus muscle,
- associated partial tear of the lateral head of the gastrocnemius muscle,
- myotendinous rupture with proximal retraction of the muscle and masslike appearance between the popliteus tendon and lateral head of the gastrocnemius,
- associated tears of the anterior cruciate ligament and arcuate complex, and
- bone contusions in the lateral compartment.

Suggested reading:

Leekam RN, Agur AM, McKee NH. Using sonography to diagnose injury of plantaris muscles and tendons. AJR 1999;172:185 -189.

JT. Bencardino, ZS. Rosenberg, RR. Brown, A. Hassankhani, MD, ES. Lustrin, and J. Beltran. Traumatic Musculotendinous Injuries of the Knee: Diagnosis with MR Imagin. Radiographics. 2000;20:S103-S120.
D
A. Jamadar, JA. Jacobson, SE. Theisen, DR. Marcantonio, DP. Fessell, SV. Patel and CW. Hayes. Sonography of the Painful Calf: Differential Considerations. AJR 2002; 179:709-716.
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