From the Guidelines
The treatment for a full thickness Anterior Talofibular Ligament (ATFL) tear should begin with functional treatment, including exercise therapy and functional support, rather than immobilization or surgery, as recommended by the most recent evidence-based clinical guideline 1.
Key Considerations
- The initial treatment approach should focus on reducing pain and swelling, with the use of NSAIDs such as ibuprofen or naproxen for 1-2 weeks 1.
- Functional support, including the use of a brace, is preferred over immobilization to provide stability while the ligament heals 1.
- Exercise therapy should be started as soon as possible to recover joint functionality, focusing on range of motion exercises, proprioception training, and progressive strengthening of the peroneal muscles 1.
- Surgery may be considered for patients who require quick recovery, such as professional athletes, or those whose complaints are not resolved by conservative treatment 1.
Treatment Modalities
- Functional support: The use of a brace or tape to provide stability and support to the ankle joint 1.
- Exercise therapy: A program of exercises to improve range of motion, proprioception, and strength of the peroneal muscles 1.
- NSAIDs: The use of non-steroidal anti-inflammatory drugs to reduce pain and swelling 1.
- Surgery: May be considered for patients who require quick recovery or those whose complaints are not resolved by conservative treatment 1.
Rehabilitation and Return to Activity
- The rehabilitation program should focus on progressive weight-bearing and a structured physical therapy program for 3-6 months 1.
- Full recovery and return to sports activities generally takes 4-6 months 1.
- Supervised exercises are advised with the focus on proprioception, strength, coordination, and function to prevent chronic instability and ensure a safe return to activity 1.
From the Research
Treatment Options for Full Thickness ATFL Tear
- The treatment for a full thickness Anterior Talofibular Ligament (ATFL) tear typically involves surgical procedures, as chronic instability often requires intervention beyond conservative measures 2, 3.
- Arthroscopic repair of the ATFL has gained popularity due to its minimal invasiveness and high efficacy, allowing for anatomic restoration of the injured ligament and providing stability to the ankle joint 2, 3, 4, 5.
Arthroscopic Repair Techniques
- Various arthroscopic techniques are employed, including all-inside arthroscopic ATFL repair, which provides favorable clinical outcomes and high patient satisfaction rates 4.
- The use of a 2-portal technique has also been described, offering a minimally invasive approach with reduced postoperative pain and faster recovery 3.
- The Internal Brace and lasso-loop technique is another method used in arthroscopic ATFL repair, demonstrating satisfactory clinical outcomes and high safety and reliability for chronic ankle lateral instability 5.
Comparison with Open Reconstruction
- Studies have compared all-arthroscopic repair with open Broström repair, finding that clinical outcomes do not differ substantially between the two methods, but all-arthroscopic repair may offer a quicker return to activity and sports, as well as a lower overall complication rate 6.
Clinical Outcomes and Complications
- Clinical outcomes following arthroscopic ATFL repair have been reported to be excellent, with significant improvements in pain scores, functional outcomes, and patient satisfaction 4, 5.
- Complications are rare, but may include neurapraxia of the superficial fibular nerve, as well as other potential risks associated with arthroscopic procedures 4, 5.