Which finding is most consistent with a complete tear of the ATFL?

Which finding is most consistent with a complete tear of the ATFL?

• A. Negative anterior drawer with no laxity
• B. Positive anterior drawer test with marked instability
• C. Positive talar tilt test only
• D. Local pain without laxity

Answer: (B)

When the ATFL is completely torn, the ankle loses the main restraint against forward (anterior) movement of the talus relative to the tibia, especially with the foot in plantarflexion. This produces marked laxity on the anterior drawer test, meaning the clinician can translate the talus forward with little resistance and clearly feel instability. That is why a test result showing a positive anterior drawer with pronounced instability is the finding most consistent with a complete ATFL rupture. Options that show no laxity or only pain without instability don’t fit a complete tear, and a positive talar tilt test alone points more toward the calcaneofibular ligament or other structures, not a complete ATFL rupture in isolation.

When the ATFL is completely torn, the ankle loses the main restraint against forward (anterior) movement of the talus relative to the tibia, especially with the foot in plantarflexion. This produces marked laxity on the anterior drawer test, meaning the clinician can translate the talus forward with little resistance and clearly feel instability. That is why a test result showing a positive anterior drawer with pronounced instability is the finding most consistent with a complete ATFL rupture.

Options that show no laxity or only pain without instability don’t fit a complete tear, and a positive talar tilt test alone points more toward the calcaneofibular ligament or other structures, not a complete ATFL rupture in isolation.