Ankle Injury Case Study: ATFL and CFL Sprain in a Tennis Player

This report presents a case study of a 24-year-old female tennis player suffering from a Grade 2 ATFL (anterior talofibular ligament) and a Grade 1 CFL (calcaneofibular ligament) sprain. It begins with an introduction to ankle sprains, their prevalence in sports injuries, and the supporting ligaments. The report then details the grading and severity of ankle injuries, distinguishing between Grade 1 (microscopic stretching), Grade 2 (macroscopic stretching with moderate symptoms), and Grade 3 (complete ligament rupture). The anatomy of the ankle injury, specifically the ATFL, is discussed, along with the biomechanics of ankle injuries, emphasizing the role of ligament integrity and the impact of foot structure. The report also covers rehabilitation strategies, including range of motion exercises, strengthening exercises, and control and balance exercises. References to relevant research articles are provided to support the information presented.

Ankle Injury

Scenario
• A 24 years old female tennis player is suffering
from grade 2 ATFL and grade 1 calcaneofibular
ligament sprain.

Introduction to Injury
• Among various musculoskeletal injuries, ankle sprain
incidences covers about 15 to 20% of the total number of
sports injuries.
• The ankle is supported by various ligaments from various
positions. It is supported laterally by calaneofibular
ligament (CFL), anterior talofibular ligament (ATFL),
posterior talofibular ligament (PTFL) and (Kadel, 2017).
• Such kinds of ankle sprain are acute and are further
classified into three different grades on the basis of
severity of injury.

Grading and Severity of Injury
According to the traditional grading system of
ligament injuries-
• Grade 1 signifies that the ligament get stretched at
microscopic level and known as microscopic injury.
• It is a moderate type of injury that will show a little
tenderness and swelling with no loss of function
• The patient reported in the case is suffering grade
1 CFL injury and will show the above mentioned
physiological issues.

Grading and Severity of Injury
• Grade 2 signifies that there is a stretching in
ligament at macroscopic level; however, the
ligament is still intact.
• There will be moderate level of swelling and
impact on the functionality. There will be
reduced ROM, proprioception and instability.
• The patient reported in the case is having grade
2 ATFL injury and will show these symptoms
(Keane et al., 2013, p 32).

Grading and Severity of Injury
• Grade 3 signifies that there is a complete
rupturing of the ligament.
• There is high swelling, pain and loss of
function of the ligament.
• There is an enhancement of instability within
the person (Taylor, 2017, p 32).

Anatomy of ankle injury-
• The most frequently damaged
ligament among the sports
person is anterior talofibular
ligament (ATFL).
• The mechanism of sprain
injury and their anatomical
location mean that the
posterior talofibular and
calcaneo fibular are quite
unlikely carry any damaging
load(Williams et al. ,2016).
• The stab
• The distal Tibio-fibular
syndesmosis stabilising
ligaments are the transverse
anterior-inferior, posterior-
inferior tibio-fibular ligaments
and, inferior transverse
ligament and the interosseous
membrane ligament.
• A severe ankle sprain occurs
along with dorsiflexion of
ankle and external rotatio of
leg. (Kearney et al., 2015, p
45).

Biomechanics of Ankle injury
• The biomechanics of ankle joint is quite complex and it
largely depends on the integrity of ankle ligament.
• After the trauma, the pain is inevitable that is due to injury
caused to antero-fibular ligament eventually leading to
mechanical dissociation of talus from ankle-mortise.
• The non-physiological movement of feet required a force
that is dependent on individual’s configuration of bony
structure of hind foot and articular structure. (Bamber, Fog
& Healer, 2018, p 22).
• As compare to flat foot, pes cavus are less protected to
suffer from the ankle sprain.

Biomechanics of Ankle injury
• With the decrease in peroneal muscle leverarm, there is
an increase in the plantarflexion of the foot. It resulted in
lack of protection from the supination stress (Kearney et
al., 2015, p 45).
• The objective of treating ankle spray is it needs to re-
activate the mechanical action of ankle joint. The orthoses
at ankle has a greater role to play against excessive plantar
flexion and supination stress.
• The ankle injury prevention can be improved significantly
by recognition of mechanical disposition of individual
(Taylor, 2017, p 32).

Rehabilitation

Rehabilitation
Range of motion exercises- This kind of exercise begins
right after the injury.
• It is performed by putting ice on the ankle. It is
reportedly have a good outcome and give relief from
pain (Kadel, 2017).
• The two different kind of range of motion exercise
includes trace the alphabet with toe and encourage
the movement in all direction.
• The second one is to sitting on the chair with foot flat
on floor and moving the knees for 3 minutes.

Range of motion exercises