An Ultrasound Classification of Anterior Talofibular Ligament (ATFL) Injury

Yehua Cai1, Shengkun Li2, Shiyi Chen2, Yinghui Hua2, *, Jielin Shan1
1 Department of sonography, Huashan Hospital, Fudan University, Shanghai, China
2 Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China

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© 2017 Cai et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Rd, Shanghai, 200040, China; Tel: 862152888255; Fax: 862162496020; E-mail:,

Yehua Cai and Shengkun Li have contributed equally to this work.



To develop a classification of ATFL injury based on the ultrasonography.


The ultrasound images of 560 cases that had chronic ankle instability were studied from May 2012 to May 2015. All the patients accepted ultrasonography to type the ATFL injury.


The ATFL injuries could be divided into six subtypes based on ultrasound imaging: I: Intact ligament; II: Injury at the fibular side; III:Injury at the talar side; IV: Tear at the midsubstance; V:Ligament absorbed; VI:Combined injury.


Ultrasound could be used to evaluate and type the injury of ATFL. This kind of classification could be helpful in the preoperative decision of ATFL procedure.

Keywords: Ankle, Anterior talofibular ligament, Injury, Ultrasound, Classification.