ATF Ligament Tears

What is it: The most common ankle sprain occurs on the outside or lateral aspect of the ankle. The lateral ankle is supported by a group of three ligaments called the lateral collateral ligaments. The anterior ligament is the ligament that is most often injured in lateral ankle sprains. This ligament is called the anterior talo-fibular ligament (ATF).

Important Facts: The anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) are sequentially the most commonly injured ligaments when a plantar-flexed foot is forcefully inverted.

Statistics: Inversion injuries of the ankle account for 40% of all athletic injuries.

Isolated ATF sprains make up more than 75% of all ankle sprains.

Treatment Duration: Following the ankle sprain, management of the acute injury is best summarized by the acronym RICE; R- rest, I- ice, C- compression, E- elevation.

There are four ways available to manage an ankle ligament sprain/rupture. These are either to do nothing and simply wait for the ankle to settle. Secondly is to immobilize the injured ankle in a plaster cast for a period of 4-6 weeks, walking as comfortable. Thirdly, to use functional rehabilitation to treat the sprained ankle (a graded physical therapy program, often combined with a removable ankle brace). The final option is to operatively repair the injured ligaments.

Do’s/Don’ts: Do wear a brace during rehab.

Do focus on “proprioception” or joint sense exercises.

Don’t reinjure the ankle by returning to playing sport too soon.

Common Myths: As soon as the swelling goes down and the ankle pain stops, I can return to playing sports again. By six weeks following an ankle sprain one should expect a 90% chance of being back to a good level of function. However, it is likely that at this stage following an ankle sprain you are likely still to have some residual symptoms of pain or instability from the ankle joint. Even by six months following an ankle sprain there is still a 20-30% chance of suffering with some level of minor discomfort or instability from the joint.