The anterior talofibular ligament: A detailed morphological study

• Anterior talofibular ligament (ATFL): one (22.9%), two (56.3%) and three (20.8%) band forms.
• ATFL originates 10.37 mm anterosuperior to the fibular lateral malleolar tip.
• ATFL inserts to the talar body 3.92 mm anterior to the anterior lateral malleolar line (ALML).
• ATFL is most taut in plantarflexion (length: 21.06 mm) and inversion (length: 20.26 mm).

The anterior talofibular ligament (ATFL) is commonly injured and may result in ankle instability. Good results from ATFL reconstruction have been reported; however complications and movement restrictions have also been observed. ATFL differences have been reported; however details of its precise bony attachment are lacking. This study provides a detailed morphology of the ATFL with respect to surgical and clinical applications. ATFL morphology, number of bands and the exact insertion points were studied in 50 formaldehyde embalmed feet. ATFL length was measured in different joint positions to assess its functional role: ATFL length varied from 18.81 mm in dorsiflexion to 21.06 mm in plantarflexion: mid-length width and thickness were 4.97 mm and 1.01 mm respectively. The bony attachment lengths were also measured: mean proximal and distal bony attachment lengths were 4.68 mm and 3.1 mm respectively, while 13.04 mm had no bony attachment. One (22.9%), two (56.3%) and three (20.8%) band morphologies were observed originating 10.37 mm anterosuperior to the lateral malleolar tip and inserting 3.92 mm anterior to the anterior lateral malleolar line (ALML). Detailed morphology of the ATFL may help in restoring injured ATFL function by appropriate ligament reconstruction, as well as aid the understanding of the mechanism of ligament injury.