The ATFL is the most commonly injured ligament in the body, torn in 85% of ankle sprains. It runs nearly horizontally from the fibula to the talar neck in plantarflexion, making it the most vulnerable position for inversion sprains. The anterior drawer test (anterior tibial displacement with the ankle in 20 degrees plantarflexion) specifically stresses the ATFL. Grade III ATFL tears with CFL involvement produce combined anterior and talar tilt instability.
| Origin | Anterior border of the lateral malleolus |
|---|---|
| Insertion | Anterior lateral talar neck (lateral articular facet) |
| Actions | Primary restraint against anterior talar displacement in plantarflexion; the weakest lateral ankle ligament and the first to tear in inversion sprains |
|---|
Stress radiography (anterior drawer and talar tilt) objectifies ankle instability. Greater than 10 mm anterior drawer or greater than 9 degrees talar tilt indicates significant lateral instability. Functional rehabilitation (proprioception, peroneal strengthening) resolves 85-90% of lateral ankle sprains. Chronic instability (recurrent sprains, positive stress tests after 3-6 months rehabilitation) warrants Brostrom-Gould repair.
ATFL tear from plantarflexion-inversion producing anterior lateral ankle pain managed with RICE, functional rehabilitation, and Brostrom repair for chronic instability.
