Review Question - QID 218575

An 18-year-old male basketball player presents to your clinic for evaluation of his persistent ankle pain. Approximately nine months ago, he sustained an inversion injury to his ankle. He has tried over-the-counter medications, ice, and bracing with minimal relief. On exam, his ankle is stable to anterior drawer in both dorsiflexion and plantarflexion. He has an ankle joint effusion. He has no pain with subtalar motion. On talar tilt stress radiographs, there are 2 degrees of talar tilt. Which of the following is the likely pathophysiology of his underlying condition?