Axial MRI best reveals chronic flexor retinaculum sleeve avulsion at the medial malleolus

On ankle MRI, chronic periosteal sleeve avulsion of the flexor retinaculum is easily missed on coronal views alone. The axial sequence clearly demonstrates the retinaculum wrapping around the medial malleolus tip instead of inserting sharply, with associated chronic scar plate a…

• Teaching point: The retinaculum fails to insert sharply on the medial malleolus tip, a finding most conspicuous on axial sequences.
• Mechanism: Represents chronic periosteal stripping, leaving a scar plate at the avulsion site.
• Source is a brief, practical educational video focused on MRI interpretation pearl.

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