Surgery for ATFL injuries

An anterior talofibular ligament (ATFL) injury is one of the most common ankle ligament injuries, usually caused by twisting the ankle. Most people recover with rest and physiotherapy, but in some cases, surgery may be recommended.

What is the ATFL and how does it get injured?

The ATFL is one of the main ligaments on the outside of the ankle. It helps stabilise the ankle joint and prevents it from rolling forwards. Injury often happens during sports, uneven ground walking or sudden twisting movements. Symptoms include pain, swelling, bruising and a feeling of instability.

When is surgery needed for an ATFL injury?

Surgery is not always the first option. Many ATFL injuries heal with rest, bracing and physiotherapy. However, surgery may be considered if:

• the ankle keeps giving way or feels unstable despite rehabilitation;
• the ligament is completely torn;
• there are repeated sprains affecting daily activities or sports;
• other structures like cartilage or tendons are also damaged.

What types of surgery are available?

The main goal of surgery is to stabilise the ankle by repairing or reconstructing the damaged ligament. Common surgical options include:

• Direct ligament repair (Broström procedure): the torn ligament is tightened and stitched back to the bone.
• Ligament reconstruction: a tendon from your foot or leg, or a donor tendon, is used to replace the damaged ligament if it cannot be repaired.
• Arthroscopy (keyhole surgery): sometimes used to check for and treat cartilage injuries inside the ankle during the procedure.

What is the recovery process like?

Recovery after ATFL surgery happens in stages:

• A boot or cast is worn for the first few weeks to protect the ankle.
• Weight bearing is usually increased gradually.
• Physiotherapy begins to restore movement, balance and strength.
• Most patients return to normal daily activities within 8 to 12 weeks.
• Returning to sports can take 3 to 6 months, depending on healing and strength.

What are the possible risks?

Every operation carries risks, although serious complications are uncommon. Potential risks include:

• infection;
• stiffness or reduced ankle movement;
• nerve irritation causing numbness or tingling;
• continued ankle instability;
• blood clots.

How can I improve my recovery?

• Follow physiotherapy exercises as advised
• Wear the brace or boot for as long as recommended
• Avoid high-impact activities until your surgeon confirms it is safe
• Maintain a healthy weight to reduce strain on the ankle