The ATFL is the weakest lateral ankle ligament (tensile strength 140 N) and the first to fail in the 70% of ankle sprains involving the lateral ligament complex. It runs nearly horizontally from the fibula to the talar neck in the neutral position, becoming oriented more vertically in dorsiflexion. The anterior drawer test assesses ATFL integrity — anterior talar translation of more than 5 mm or 3 mm more than the opposite side indicates ATFL rupture.
| Origin | Anterior border of the lateral malleolus |
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| Insertion | Lateral talar neck (anterior to the lateral articular surface) |
| Actions | Primary restraint against anterior talar translation in plantarflexion — tightest in plantarflexion, most at risk during inversion in plantarflexion (the classic ankle sprain mechanism) |
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Grade III ATFL tear requires 6-8 weeks of protected rehabilitation before return to sport. The Brostrom-Gould repair reattaches the ATFL and CFL to the fibula using suture anchors, reinforced by the inferior extensor retinaculum advancement. The repair maintains the physiological ligament tension — superior to non-anatomical procedures (Chrisman-Snook, Watson-Jones) that use tendon grafts creating over-constraint.
Complete ATFL rupture from inversion ankle sprain managed with functional rehabilitation or Brostrom-Gould anatomical repair for chronic instability.
