Lateral Ligament Injury – ATFL & CFL Ruptures

Ankle ligament injuries are a common presentation in both athletes and the general population.

The most frequently injured structures include the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL), which form the lateral ligament complex of the ankle. These ligaments play a vital role in stabilising the ankle joint during walking, running, and pivoting movements.

If you’ve recently experienced an ankle sprain or feel persistent ankle instability, it may be due to a rupture or tear of these ligaments. Dr Daniel Meyerkort, Orthopaedic Surgeon at Perth Orthopaedic and Sports Medicine Centre, offers comprehensive non-surgical and surgical treatments tailored to your condition, activity level and lifestyle.

Understanding ATFL and CFL Ruptures

The ATFL is the most commonly injured ligament in the ankle and is often the first structure damaged during an inversion injury (when the ankle rolls inward). The CFL, located just below the ATFL, provides additional support and may be injured in more severe ankle sprains.

Symptoms of a ligament rupture can include:

  • Immediate pain and swelling on the outside of the ankle

  • Bruising

  • Difficulty bearing weight

  • A feeling of instability, especially during activity

In some cases, chronic lateral ankle instability can develop after repetitive sprains or if the initial injury doesn’t heal properly.

Diagnosis

Diagnosis begins with a clinical assessment by Dr Meyerkort, including a review of your history, physical examination, and imaging. MRI scans are often used to assess the extent of the ligament damage and to rule out other associated injuries like cartilage damage or peroneal tendon injury. Stress X-rays or ultrasound may also be considered.

Non-Surgical Management

In many cases, especially in low-grade sprains or partial ruptures, non-surgical treatment is highly effective. The goal is to restore strength, flexibility, and function.

Conservative treatment options include:

  • RICE protocol (Rest, Ice, Compression, Elevation)

  • Immobilisation in a CAM boot or ankle brace during the acute phase

  • Physiotherapy to restore range of motion, strengthen surrounding muscles and improve proprioception

  • Activity modification and anti-inflammatory medication if necessary

Dr Meyerkort works closely with experienced sports physiotherapists in Perth and regional areas to ensure a tailored rehab plan. This collaborative approach helps achieve excellent outcomes in many cases without surgery.

Benefits of Non-Surgical Management:

  • Avoids risks associated with surgery

  • Suitable for most low- to moderate-grade ligament injuries

  • No recovery period from anaesthesia

  • Cost-effective

  • Most patients return to activity within 6–12 weeks

Risks and Limitations:

  • Higher risk of re-injury, particularly in athletes or those with recurrent sprains

  • May not be suitable for complete ligament ruptures or cases with chronic instability

  • Recovery may take longer than surgical repair in some high-grade injuries

Surgical Management of ATFL and CFL Ruptures

When non-surgical treatment fails, or in cases of complete rupture or significant mechanical instability, surgical reconstruction or repair may be recommended.

Indications for Surgery:

  • Persistent ankle instability despite rehab

  • Complete rupture of ATFL and/or CFL

  • Associated injuries (e.g. cartilage damage, syndesmosis injury)

  • High-demand athletes requiring reliable joint stability

  • Chronic instability from previous ankle injuries

Dr Daniel Meyerkort specialises in anatomic ligament repair and reconstruction, using advanced surgical techniques, including ankle arthroscopy and minimally invasive methods.

Ankle Arthroscopy and Ligament Surgery

Ankle arthroscopy is routinely performed alongside ligament repair or reconstruction. This minimally invasive procedure allows direct visualisation of the joint and identification of associated conditions like cartilage injury, scar tissue, or impingement.

Common Surgical Techniques:

  1. Broström-Gould Procedure – Direct repair of the ATFL and CFL, often using suture anchors.

  2. Ligament Reconstruction – In cases where ligaments are too damaged for direct repair, a tendon graft (typically using a peroneus brevis or hamstring tendon) is used.

  3. Arthroscopy – Addressing intra-articular pathology such as cartilage damage or loose bodies before or during ligament surgery.

Benefits of Surgery

  • Reliable restoration of ankle stability

  • Allows return to high-level sport or activity

  • Lower recurrence rate compared to conservative treatment

  • Improves long-term joint function and reduces risk of arthritis

  • Corrects mechanical instability when rehab alone is insufficient

Risks of Surgery

Like all surgical procedures, ligament reconstruction carries some risks:

  • Infection

  • Nerve injury, particularly to the superficial peroneal nerve

  • Stiffness or ongoing pain

  • Thrombosis (DVT)

  • Graft failure or over-tightening

  • Prolonged rehabilitation compared to mild sprains

However, under the care of an experienced sports ankle surgeon like Dr Meyerkort, these risks are minimised with careful technique, patient selection, and post-op care.

Postoperative Rehabilitation

Rehab plays a critical role in surgical success. After surgery, patients typically wear a boot or brace for 4–6 weeks, followed by physiotherapy for strength, mobility and return to sport.

Most patients can:

  • Begin light activity at 8–12 weeks

  • Return to running between 3–4 months

  • Return to sport between 4–6 months depending on the procedure and sport-specific demands

Why Choose Dr Daniel Meyerkort at Perth Orthopaedic & Sports Medicine?

Dr Daniel Meyerkort is a fellowship-trained orthopaedic surgeon with expertise in sports injuries, minimally invasive surgery, and arthroscopic ankle procedures. He sees patients in West Perth and also offers Telehealth appointments for rural and regional patients.

Key reasons patients choose Dr Meyerkort:

  • Timely access to assessment and imaging

  • Evidence-based approach to ankle ligament injuries

  • Access to modern surgical techniques and technology

  • Coordination with local physiotherapists for post-op rehab

Personalised Orthopaedic Care in Perth

If you’ve suffered an ankle sprain that isn’t improving or feel like your ankle “gives way,” it’s time to get a professional opinion. Book a consultation with Dr Daniel Meyerkort at Perth Orthopaedic and Sports Medicine Centre to explore your options for diagnosis, treatment, and recovery.

Call us on (08) 9212 4200 or book online at www.perthortho.com.au