Excessive anterior translation on the anterior drawer ankle test indicates injury to which ligament?

• A. ATFL injury
• B. Deltoid ligament injury
• C. Calcaneofibular ligament injury
• D. Syndesmotic injury

Answer: (A)

The test is designed to stress the anterior talofibular ligament by pulling the heel forward while the foot is placed in slight plantarflexion. The ATFL connects the front of the fibula to the talus, and it’s the primary stabilizer against forward (anterior) movement of the talus when the ankle is plantarflexed. If this ligament is torn or lax, the talus can translate forward more than normal, producing excessive anterior translation. That’s why excessive anterior translation on this test points to an ATFL injury.

In contrast, injury to the deltoid ligament (the strong medial supports) would show medial instability and changes in the medial clear space, not just forward movement. The calcaneofibular ligament is a lateral stabilizer that mainly resists inversion; its injury affects lateral stability but is not the classic cause of abnormal forward translation on this test. Syndesmotic injuries involve the high ankle ligaments between the tibia and fibula and are typically assessed with different maneuvers (like external rotation or squeeze tests).