Return to sport in athletes after surgical ankle fractures: A systematic review

Abstract

Purpose: Ankle fractures represent a significant health concern for athletes, comprising 15%–25% of all sports-related injuries. With increasing sports participation across all age groups, the public health impact of these injuries is expected to grow. Open reduction and internal fixation (ORIF) is a common approach to managing ankle fractures, particularly for athletes requiring rapid return to sports. However current information on the return to sports post-injury is largely anecdotal. Methods: A comprehensive literature search was conducted using keywords related to ankle fractures and sports return. Databases searched included Medline (PubMED), Cochrane and Google Scholar up to 12 April 2024. Articles published in English, Spanish, French, Portuguese, and Italian were considered. A total of 17 studies involving 1422 patients were analysed. Inclusion criteria covered randomised controlled trials and case series of over 10 patients focused on athletes with closed ankle fractures. Studies on paediatric fractures, soft tissue injuries, and non-sports-related fractures were excluded. Results: The review analysed various types of ankle fractures, with an average patient age of 31.4 years. ORIF was the predominant treatment (89.4%), and the average return-to-sport rate was 87.1%. Time to return varied, with an average of 134.5 days. Recovery time was longer for more severe fractures, such as bimalleolar and trimalleolar fractures, which showed times of up to 720 days. Functional outcomes improved with early rehabilitation, and the average Foot and Ankle Outcome Score (FAOS) for sports was 85.6 after 12 months. Conclusion: Returning to sports after an ankle fracture is a critical concern for athletes. This systematic review provides valuable insights into the prognosis and timeline for resuming sports activities. By synthesising current evidence, it offers guidance for clinicians and athletes on managing recovery and optimising return to sports. Standardised, high-quality studies are needed to provide clearer guidelines. Level of Evidence: Level III. For Clinical Trials: PROSPERO registration number 594839.