[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) › ATFL [Joints and ligaments](https://durgical.com/en/anatomy/system/joints-and-ligaments/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) # ATFL The anterior talofibular ligament (ATFL), at the front of the outer ankle, is the ligament most often hurt in an ankle sprain. Official name: Anterior talofibular ligament [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=lower_limb&select=atfl&side=r) Opens in the Durgical app, no sign-up needed. ## What it is A small, flat ligament on the front of the outer ankle, from the fibula to the talus. ## What it does Stops the talus from sliding forward and resists the ankle rolling inward, especially when the foot is pointed. ## Key points - First ligament to tear when the foot rolls inward while pointed: plantarflexion turns the ATFL vertical and puts the narrower front of the talar dome in the mortise, so the ankle is least stable - Usual sequence as force increases: ATFL, then CFL, then (rarely) [PTFL](https://durgical.com/en/anatomy/posterior-talofibular-ligament/) - Tested with the anterior drawer; a delayed exam a few days after the sprain, when swelling has settled, is more accurate than one on the day of injury ## Key facts **Attaches** Anterior border of lateral malleolus to neck of talus **Function** Limits anterior displacement of talus and inversion; weakest lateral ligament, most commonly sprained **Tight in** Plantarflexion with inversion ## Relations **Above** Anterior inferior tibiofibular ligament of the syndesmosis; its lowest slip (Bassett's ligament) can rub on the [talus](https://durgical.com/en/anatomy/talus/) and cause anterolateral impingement **Below** CFL, which arises just below it near the tip of the [fibula](https://durgical.com/en/anatomy/fibula/) **Deep** Ankle [joint capsule](https://durgical.com/en/anatomy/articular-capsule-of-knee-joint/), of which it is a thickening, and the lateral talar dome in the anterolateral gutter **Superficial** [Skin](https://durgical.com/en/anatomy/skin/) and branches of the [superficial fibular nerve](https://durgical.com/en/anatomy/superficial-fibular-nerve/) (intermediate dorsal cutaneous nerve), at risk in lateral ligament repair and anterolateral arthroscopy portals ## How to find it A soft hollow just in front of the lateral malleolus, running forward to the talar neck; tenderness here without bony tenderness fits an ATFL sprain. It is felt best with the foot slightly pointed and turned in. ## Examination - Anterior drawer: ankle in slight plantarflexion, [tibia](https://durgical.com/en/anatomy/tibia/) held still, heel drawn forward; more glide than the other side, a soft endpoint or a dimple below the front of the fibula suggests an ATFL tear - Talar tilt (inversion stress) in plantarflexion mainly stresses the ATFL; more tilt than the other side suggests laxity ## On imaging Ottawa ankle rules: X-rays are needed if there is malleolar pain plus bone tenderness on the back edge or tip of the lower 6 cm of either malleolus, or the person cannot take four steps both right after the injury and in the emergency department. X-rays look for fractures; ultrasound (dynamic, during a drawer) or MRI shows the ligament itself. ## Common problems - Ankle sprain: rolling the ankle inward stretches or tears it. It is the most commonly injured ankle ligament. - Chronic instability: after repeated sprains, the ankle may keep giving way. - Often injured together with the CFL. ## How it is diagnosed A physical exam (swelling, tenderness, anterior drawer test). X-rays rule out a fracture. MRI or ultrasound for ongoing problems. ## Treatment - Most sprains heal without surgery: rest, ice, compression, a brace or boot, then balance and strengthening exercises. - Chronic instability: surgery to repair and tighten the ligament. - If the ligament tissue is poor: reconstruction with a tendon graft from the patient or a donor. ## Clinical notes - Grades: I, fibres stretched with no laxity; II, partial tear with some laxity; III, complete tear with clear laxity, often with the CFL - Chronic lateral instability: anatomic repair shortens and reattaches the ATFL to the fibula (Broström type), often reinforced with the inferior [extensor retinaculum](https://durgical.com/en/anatomy/extensor-retinaculum-of-the-wrist/) - Repeated sprains can leave scar or synovial tissue in the anterolateral gutter that catches on the talus (anterolateral impingement) - A sprain-like injury may hide a fracture of the lateral talar process, the anterior calcaneal process or the [fifth metatarsal](https://durgical.com/en/anatomy/fifth/) base, or a high ankle sprain ## Anatomical variants - May be a single band or have two (sometimes three) separate bands; texts differ on how often each pattern occurs ## Memory aid ATFL: "Always Tears First". ## Related conditions - [Lateral Ankle Sprain](https://durgical.com/en/conditions/lateral-ankle-sprain/) ## Test yourself Think of the answer, then tap the question to see it. ## Where does the anterior talofibular ligament (ATFL) attach? From the anterior border of the lateral malleolus to the neck of the talus. ## In which foot position is the anterior talofibular ligament most often torn? Plantarflexion with inversion: the ATFL turns vertical and the narrower front of the talar dome sits in the mortise. ## Which test assesses the anterior talofibular ligament? The anterior drawer: more forward glide than the other side, a soft endpoint or a dimple suggests an ATFL tear. ## In what order are the lateral ankle ligaments usually torn as force increases? ATFL, then CFL, then (rarely) PTFL. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/anterior-talofibular-ligament/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** ligamentum talofibulare anterius TA2 1919 **Official Spanish (DeCS)** Ligamento talofibular anterior DeCS D017844 **English (TA2)** Anterior talofibular ligament **Also called** ligamentum fibulotalare anterius ## Related - [CFL](https://durgical.com/en/anatomy/calcaneofibular-ligament/) - [PTFL](https://durgical.com/en/anatomy/posterior-talofibular-ligament/) - [Syndesmosis ligaments](https://durgical.com/en/anatomy/anterior-tibiofibular-ligament/) - [Fibula](https://durgical.com/en/anatomy/fibula/) - [Talus](https://durgical.com/en/anatomy/talus/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=31367&filter=ths_termall&q=Ligamentos%20Laterales%20del%20Tobillo); [Anatomy, Bony Pelvis and Lower Limb: Ankle Joint](https://www.ncbi.nlm.nih.gov/books/NBK545158/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/anterior-talofibular-ligament/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/anterior-talofibular-ligament/