What are the most common ligaments involved in lateral ankle sprains?

From the Guidelines

The most common ligaments involved in lateral ankle sprains are the anterior talofibular, calcaneofibular, and posterior talofibular ligaments. These ligaments are typically damaged in a sequential pattern, with the anterior talofibular ligament being the most frequently injured, as it is the weakest of the lateral ankle ligaments and is placed under tension during plantarflexion and inversion, the most common mechanism of injury 1. The typical ankle sprain is an inversion injury that occurs in the plantar-flexed position, and the lateral stabilizing ligaments, including the anterior talofibular, calcaneofibular, and posterior talofibular ligaments, are the most easily injured 1. Some key points to consider about these ligaments include:

• The anterior talofibular ligament is the most vulnerable due to its weakness and position under tension during plantarflexion and inversion
• The calcaneofibular ligament becomes the primary stabilizer when the ankle is in dorsiflexion, making it susceptible to injury when the anterior talofibular ligament has already been compromised
• The posterior talofibular ligament is the strongest of the three and is rarely injured in isolation, usually only becoming damaged in severe ankle injuries or dislocations Understanding this anatomical vulnerability helps explain why the lateral ligament complex is most commonly involved in ankle sprains 1.

From the Research

Lateral Ankle Sprains

• The most common ligaments involved in lateral ankle sprains are the anterior talofibular ligament and the calcaneofibular ligament, often in combination 2.
• The lateral ankle ligaments are formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL) 3.
• Connections between the ATFL, CFL, and PTFL have been found in all cases, with variable amounts of fibres 3.

Ligament Involvement

• The anterior talofibular ligament is most commonly affected in lateral ankle sprains 2.
• Ruptures of all three lateral ankle ligaments (luxatio pedis supinatoria) or complete ruptures of the medial and lateral ligaments (luxatio pedis cum talo) are extremely rare 2.
• The lateral ankle ligaments are interconnected, with medial connecting fibres between the ATFL, CFL, and PTFL 3.

Injury Mechanism

• Lateral ligament injuries occur due to supination trauma 2.
• Ankle sprains are among the most common injuries sustained by athletes and seen by sports medicine physicians, often resulting from supination trauma 4.