Elite athletes successfully return to the preinjury level of sport following ankle syndesmosis injuries: a systematic review and meta-analysis

Review written by Dr Teddy Willsey info

Key Points

  1. The suture button fixation has become the favorable surgical technique for repairing high ankle sprains.
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High ankle sprains account for approximately 25% of all ankle sprains in contact sports (1). A high ankle sprain involves injury to the distal tibiofibular syndesmosis, leading to excessive motion between the tibia and fibula, resulting in increased pain and disability. In cases that exhibit greater syndesmotic instability, surgical stabilization is warranted. The suture button fixation approach has been the preferred option in recent years. This technique offers a more complete solution compared to screw fixation, as it allows for full restoration of stability with a decreased chance of stiffness (2).

To date, no research papers have looked at return to sport (RTS) rates for elite athletes suffering high ankle sprains. Research on heterogenous groups of both competitive and recreational athletes have reported RTS ranging from 42 to 55 days for athletes, depending on conservative care versus surgery. The authors of this paper focused their review on high ankle sprains in elite athletes, providing accurate time estimates and expectations based on emergent surgical techniques and rehabilitation protocols.

High ankle sprains account for approximately 25% of all ankle sprains in contact sports.
Despite the favorable outcomes reported for suture button fixation, all surgery comes with inherent risks and should never be taken lightly.


The authors were able to identify 10 relevant articles, representing a total of 440 elite athletes, average age 24, all competing at either the collegiate or professional level. Sport representation included soccer (33%), ice hockey (28%), American football (25%), rugby

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