Talofibular Ligament Injury

Author: Marc A Molis, MD, FAAFP; Chief Editor: Sherwin SW Ho, MD more...

Updated: Jul 15, 2011

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Background
Epidemiology
Functional Anatomy
Sport-Specific Biomechanics
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Background

Ligamentous injuries of the ankle are common among athletes.^{[1, 2]}Inversion injuries of the ankle account for 40% of all athletic injuries. 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. The posterior talofibular ligament (PTFL) is rarely injured, except in association with a complete dislocation of the talus.^{[3, 4, 5]}

Ligamentous injuries of the ankle are classified into the following 3 categories, depending on the extent of damage to the ligaments:^{[6, 7, 8, 9, 10]}

Grade I is an injury without macroscopic tears. No mechanical instability is noted. Pain and tenderness is minimal.
Grade II is a partial tear. Moderate pain and tenderness is present. Mild to moderate joint instability may be present.
Grade III is a complete tear. Severe pain and tenderness, inability to bear weight, and significant joint instability are noted.

For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center and Sprains and Strains Center. Also, see eMedicine's patient education articles Ankle Sprain and Sprains and Strains.

Related eMedicine topics:

Ankle Impingement Syndrome

Ankle Injury, Soft Tissue

Ankle Sprain

Ankle Taping and Bracing

Related Medscape topics

Resource Center Exercise and Sports Medicine

Resource Center Joint Disorders

Specialty Site Orthopaedics

Frequency

United States

Approximately 3600 cases of talofibular ligament injury per 100,000 people are reported per year.

Functional Anatomy

The lateral articular capsule of the ankle can be divided into anterior and posterior segments. The anterior segment attaches proximally to the anterior portion of the distal tibia superior to the articular surface and to the border of the articular surface of the medial malleolus. The posterior segment attaches distally to the talus just posterior to its superior articular facet and attaches laterally to the depression in the medial surface of the lateral malleolus.^{[3, 4, 5]}

The ATFL is intracapsular and attaches anteriorly to the anterior border of the distal fibula and laterally to the neck of the talus. The PTFL attaches posteriorly to the digital fossa of the fibula and laterally to the lateral tubercle on the posterior portion of the talus.

Sport-Specific Biomechanics

The talofibular ligaments along with the CFL are components of the lateral ligament complex. This complex becomes stressed when the ankle is inverted and plantar flexed.^[11]Supination of the foot in neutral flexion usually results in injury of the CFL. Supination and adduction injuries tear both the ATFL and the CFL.

The PTFL is the strongest of the lateral ligaments, and extreme inversion with plantar flexion is required to place the PTFL under stress; as a result, the PTFL is less commonly injured.^[11]Transient subluxation or dislocation of the talus from the tibial mortise usually results in injury of all 3 lateral ligaments. Prevention of anterior displacement of the talus is primarily a function of the ATFL. Little additional motion occurs when the CFL also is damaged. Instability to inversion is greater when both the CFL and the ATFL are injured than when either ligament is injured alone.

Proceed to Clinical Presentation

Contributor Information and Disclosures

Author

Marc A Molis, MD, FAAFP Medical Director of Sports Medicine, Sports Medicine of Iowa

Marc A Molis, MD, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, American Medical Society for Sports Medicine, and Iowa Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

David F Martin, MD Program Director, Associate Professor, Department of Orthopaedic Surgery, Wake Forest University School of Medicine

David F Martin, MD is a member of the following medical societies: American College of Sports Medicine, American College of Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, International Society on Thrombosis and Haemostasis, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Michael Taylor, MD, to the development and writing of this article.

References

Brukner P, Khan KM. Acute ankle injuries. Clinical Sports Medicine. 3^rd ed. San Francisco, Calif: McGraw-Hill; 2006.
Jackson MD, Moeller JL, Hough DO. Basketball injuries. In: Sallis RE, Massimino F, eds. American College of Sports Medicine's Essentials of Sports Medicine. New York, NY: Churchill Livingstone; 1996:558-9.
Fong BL, Brunet ME. The leg, ankle, and foot. In: Perrin DH, ed. The Injured Athlete. 3^rd ed. Philadelphia, Pa: Lippincott-Raven; 1999:432-9.
Jayanthi N. Lower leg and ankle. In: McKeag DB, Moeller J, eds. ACSM's Primary Care Sports Medicine. 2^nd ed. Philadelphia, Pa: Lippincott, Williams and Wilkins; 2007.
Magee D. Lower leg, ankle, and foot. Orthopedic Physical Assessment. 4^th ed. Toronto, Canada: Elsevier Sciences; 2006.
Brage ME, Colville MR, Early JS. Ankle and foot: trauma. In: Beaty JH, ed. Orthopaedic Knowledge Update 6. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999:597-612.
Breitenseher MJ. [Injury of the ankle joint ligaments] [German]. Radiologe. Mar 2007;47(3):216-23. [Medline].
Rubin A. Ankle ligament sprains. In: Sallis RE, Massimino F, eds. American College of Sports Medicine's Essentials of Sports Medicine. New York, NY: Churchill Livingstone; 1996:450-2.
Schepsis AA. Ligamentous injuries of the ankle. In: Yablon IG, Segal D, Leach RE, eds. Ankle Injuries. New York, NY: Churchill Livingstone; 1983:193-208.
Scranton PE. Ankle and foot: trauma. In: Fitzgerald RH Jr, ed. Orthopaedic Knowledge Update 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1987:447-54.
Haraguchi N, Toga H, Shiba N, Kato F. Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome. Am J Sports Med. Jul 2007;35(7):1144-52. [Medline].
Garrett WE Jr. Trauma: soft tissue. In: Fitzgerald RH Jr, ed. Orthopaedic Knowledge Update 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1987:89-96.
Harmon KG. Which support is best for first-time ankle sprains?. Clin J Sport Med. Jul 2007;17(4):333-4. [Medline].
Mellion MB, Walsh WM, Shelton GL, eds. The Team Physician's Handbook. 3^rd ed. Philadelphia, Pa: Hanley and Belfus; 2002.
Simons S. Rehabilitation of ankle injuries. In: Sallis RE, Massimino F, eds. Simons S. Rehabilitation of ankle injuries. New York, NY: Churchill Livingstone; 1996:458-61.
Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev. Apr 18 2007;CD000380. [Medline].
Anderson RB. Ankle and foot: reconstruction. In: Kasser JK, ed. Orthopaedic Knowledge Update 5. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1996:525-48.
Mann RA. Ankle and foot: reconstruction. In: Fitzgerald RH Jr, ed. Orthopaedic Knowledge Update 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1987:455-63.
Kelikian H, Kelikian AS. Disruption of the fibular collateral ligament. In: Kelikian H, Kelikian AS, eds. Disorders of the Ankle. Philadelphia, Pa: WB Saunders; 1985:437-90.
Samoto N, Sugimoto K, Takaoka T, et al. Comparative results of conservative treatments for isolated anterior talofibular ligament (ATFL) injury and injury to both the ATFL and calcaneofibular ligament of the ankle as assessed by subtalar arthrography. J Orthop Sci. Jan 2007;12(1):49-54. [Medline].
Snell R, Smith M. The bony pelvis and lower extremity. In: Clinical Anatomy for Emergency Medicine. St. Louis, Mo: Mosby-Year Book; 1993:708-9.
Tochigi Y, Rudert MJ, McKinley TO, Pedersen DR, Brown TD. Correlation of dynamic cartilage contact stress aberrations with severity of instability in ankle incongruity. J Orthop Res. Sep 2008;26(9):1186-93. [Medline].

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