A lot of people panic when they read “ruptured” on a scan or a report. A lot of the time, it’s a cause for concern. In the case of an ATFL rupture, not so much.
The ATFL is one of three ligaments making up the lateral ankle complex, along with the PTFL and CFL. The role of the ATFL is to help stop the ankle rolling, particularly when the foot is pointing down. Not only is it the weakest of the three ligaments, it is often the first one of them to get injured in any lateral ankle injury.
Looking at the anatomy, you can see that because it is located towards the front of the ankle, relative to the CFL, it physically wouldn’t do much to stop your ankle rolling in.
Because it contributes so little to lateral ankle instability, a lot of people don’t even realise they don’t have an ATFL rupture. I found a 2017 study on MRI imaging on patients, that found that 37% will have some sort of ATFL abnormality (O’Neil 2017).
Clinical Management Of ATFL Rupture
Unless there is a chronic instability, very rarely would you reconstruct an ATFL.
Acutely, if a ruptured ATFL presented to me I would consider a boot or a brace if they were struggling to weight bear, but I would let pain dictate to me as to when to take it off. My preference would be to tape them up, as it allows my patients to walk in a more heel- toe gait.
The concern would be that they develop chronic instability in the ankle or an anterior ankle impingement long term, which would require surgery. This can occur in patients who either present to physiotherapy late, or are non- compliant with their rehab.
But as long as their other structures are stable, there is a good chance of a great outcome!
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