ATFL

The anterior talofibular ligament (ATFL) is a ligament of the ankle’s lateral collateral complex, extending from the distal anterior edge of the fibula to the neck of the talus. It lies anterior to the ankle joint and is commonly described together with the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). The ATFL is typically the weakest component of the lateral ligaments and the most frequently injured in inversion injuries.

Functionally, the ATFL helps stabilize the ankle by limiting anterior translation of the talus relative to the fibia, and it provides resistance to inversion, especially when the foot is in plantarflexion. Its role is most critical in the plantarflexed position, where it serves as the primary restraint to anterior talar movement.

Injury to the ATFL is common in lateral ankle sprains, usually produced by an inversion mechanism. Injuries are graded I to III based on laxity and functional impairment. Patients may present with swelling, tenderness over the ATFL region, and instability. Clinical tests include the anterior drawer test and talar tilt test.

Diagnosis is clinical but may be supplemented by imaging. MRI is useful to assess the integrity of the ATFL and associated structures; ultrasound or dynamic imaging can also evaluate tears. Imaging helps determine the extent of injury and guide treatment planning.

Management typically begins with conservative care: rest, ice, compression, elevation (RICE), immobilization as needed, and analgesia. Early rehabilitation emphasizes range of motion, strength, proprioception, and gradual return to activity. Surgery or reconstruction of the ATFL is considered for recurrent instability or failure of conservative treatment, with various repair and reconstruction techniques available to restore ankle stability.