From the Guidelines
The anterior talofibular ligament (ATFL) is the most commonly injured ligament in ankle sprains, as it is the weakest of the lateral ankle ligaments and is the first to be damaged in a typical ankle sprain. This ligament connects the lateral malleolus of the fibula to the talus bone and is particularly vulnerable during inversion injuries, which occur when the foot rolls inward. Approximately 85% of all ankle sprains involve the lateral ligament complex, with the ATFL being injured in about 70-80% of these cases, as stated in the study by 1.
Key Points
- The ATFL is the most commonly injured ligament in ankle sprains, due to its vulnerability during inversion injuries.
- Inversion injuries account for 25% of musculoskeletal system injuries and 50% of all sports-related injuries, as reported by 1.
- The ATFL is especially susceptible to injury during plantarflexion, as it becomes more parallel to the long axis of the leg in this position, making it taut and vulnerable to stretching or tearing when the ankle is forced into inversion.
- Treatment typically involves rest, ice, compression, and elevation (RICE protocol), followed by rehabilitation exercises to restore strength and proprioception to prevent recurrent sprains, although the study by 1 suggests that functional support and exercise therapy may be more effective than immobilization.
Evidence-Based Recommendation
Based on the most recent and highest quality study, the ATFL is the most commonly injured ligament in ankle sprains, and treatment should focus on functional support and exercise therapy to restore strength and proprioception. The study by 1 provides the most recent evidence on the diagnosis and treatment of ankle sprains, and its findings support the recommendation to prioritize functional support and exercise therapy over immobilization.
From the Research
Ankle Ligament Involvement in Ankle Sprains
- The anterior talofibular ligament (ATFL) is the most commonly injured ligament in ankle sprains, as reported in studies 2, 3, 4, 5, 6.
- The ATFL is injured in every case of lateral ankle instability, whereas the calcaneofibular ligament (CFL) and syndesmosis may be involved in severe cases 5.
- Isolated anterior talofibular ligament injury is the most common pattern of ligamentous injury, followed by combined anterior talofibular and calcaneofibular ligament strain 4.
- The posterior talofibular ligament is the strongest component of the lateral collateral ligament complex and is injured in severe ankle injury along with the other lateral collateral ligaments 4.
Ligament Injury Patterns
- Ankle sprains can result in various patterns of ligamentous injury, including:
- Isolated anterior talofibular ligament injury
- Combined anterior talofibular and calcaneofibular ligament strain
- Calcaneofibular ligament and posterior talofibular ligament strains with an intact anterior talofibular ligament (rare) 4
- The mechanism of injury, such as inversion of the foot, can result in injury to the anterior talofibular ligament alone or in conjunction with the calcaneofibular ligament and posterior talofibular ligament 6.