Elite athletes successfully return to the preinjury level of sport following ankle syndesmosis injury

Key points

1. 01The overall return-to-sport rate across all athletes was about 99%.
2. 02Athletes treated without surgery returned to play in about 4 weeks, while those who had surgery returned in about 7 weeks.
3. 03Almost all surgical cases (96%) used suture button fixation, which the authors call the gold standard for elite athletes.
4. 04The surgical complication rate was 9.1%.
5. 05This is a conference meeting abstract, so the analysis is brief and the underlying studies were mostly observational.

How it was conducted

Design

Systematic review and meta-analysis using a random-effects model

Data sources

Three electronic databases, screened independently by two reviewers

Participants

440 elite (collegiate or professional) athletes with high ankle syndesmosis injury

Groups

Nonoperative (269 athletes) versus operative (171 athletes); within surgery, screw versus suture button fixation

Primary outcome

Rate and time to return to pre-injury level of sport, plus postoperative complications

What they found

• Overall return-to-sport rate was 99% (95% CI 95.5 to 99.9).
• Overall mean time to return to sport was 38 +- 18 days (range 14 to 137).
• Nonoperative group (269/440, 61%): return-to-sport rate 99.6%, mean time 29 +- 14 days (range 13 to 45).
• Operative group (171/440, 39%): return-to-sport rate 100% (171/171), mean time 50.3 +- 13 days (range 41 to 137).
• Suture button fixation was used in 164/171 (96%) of surgical athletes, with a mean time to return to sport of 7 weeks and a 9.1% complication rate.

Limitations

• This is a conference meeting abstract rather than a full peer-reviewed paper, so methods and risk-of-bias detail are limited.
• The included studies were largely observational, with no randomization between operative and nonoperative care.
• Treatment groups likely differed in injury severity, so the faster nonoperative return time may reflect milder injuries rather than a true treatment advantage.
• Only 7 of 171 surgical athletes had screw fixation, too few to compare screw versus suture button outcomes reliably.

Why it matters

For patients

If you are a high-level athlete with a high ankle sprain, you can expect a very good chance of getting back to your sport, often within about 4 to 7 weeks depending on whether you need surgery.

For clinicians

In elite athletes, both operative and nonoperative management of syndesmotic injury yield near-universal return to play, and suture button fixation is favored when surgery is indicated.

For readers

Return-to-sport rates here are unusually high and come from observational data on elite athletes, so they should not be read as a guarantee for recreational or non-athlete patients.