The posterior talofibular ligament (PTFL) runs horizontally from the posterior surface of the lateral malleolus to the posterolateral talar body. It is the strongest of the three lateral ankle ligaments and the last to rupture in inversion ankle sprain — it is rarely torn in isolation.
Limits ankle plantarflexion; resists posterior talar displacement; the primary restraint to posterior talar displacement in the ankle mortise.
The PTFL is the strongest lateral ankle ligament and is injured only in the most severe lateral ankle sprains (Grade III, with ATFL and CFL already torn). PTFL repair is included in anatomic ankle reconstruction procedures (Brostrom-Gould) when MRI demonstrates complete tear. Posterior ankle impingement may involve the posterolateral PTFL at its talar attachment producing posterior ankle pain in plantarflexion.
PTFL tear as part of complete lateral ankle ligament disruption (ATFL + CFL + PTFL) in severe inversion injury producing gross mechanical instability, managed by acute repair or delayed anatomic reconstruction.
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