Anatomy
The lateral ligament complex consists of:
- anterior talofibular ligament (ATFL)
- calcaneofibular ligament (CFL)
- posterior talofibular ligament (PTFL)
The ATFL is injured most commonly.
Mechanism
A typical injury is inversion of a plantarflexed ankle. Greater injury may involve the CFL and, less commonly, the PTFL.
Assessment
- swelling and bruising
- tenderness over ATFL and CFL
- ability to bear weight
- bony tenderness requiring radiographs under Ottawa ankle rules
- anterior drawer test for ATFL
- talar tilt for CFL
- assess syndesmosis and peroneal tendons
Treatment
Most injuries are treated non-operatively:
- short period of protection and compression
- early weight bearing as tolerated
- restoration of range of motion
- peroneal strengthening
- proprioception and balance training
Chronic instability
Persistent recurrent giving way despite rehabilitation may require further imaging and, in selected patients, operative ligament repair or reconstruction.