• Amit Sinha, Greg Robertson, and Nicola Maffulli.
• Department of Trauma and Orthopaedic Surgery, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, UK.
• Br. Med. Bull. 2022 Sep 22; 143 (1): 35-45.

IntroductionAnkle fractures in sport are common. Their optimal management is unclear, as is when patients can return to their sports activities. This systematic review provides a contemporary assessment of the literature on return to sports following acute traumatic ankle fractures managed both operatively and non-operatively.Sources Of DataWe systematically searched Pubmed, Google Scholar, the Cochrane Library, EMBASE and CINAHL using the terms 'ankle fractures', 'ankle injuries', 'athletes', 'sports', 'return to sport', 'return to activity', 'operative management', 'non-operative management'.Areas Of AgreementThirteen retrospective studies fulfilled the inclusion criteria. The methodological quality of the studies was generally poor. The proportion of patients returning to sporting activity was high. In some studies, a quicker return to sporting activity was demonstrated in patients managed non-operatively.Areas Of ControversyThe time to return to sporting activity and level of performance post-treatment are not universally recorded, and the optimal time to return to sport remains to be confirmed.Growing PointsConservative management for stable or undisplaced fracture may result in a higher proportion of patients returning to sport more quickly.Areas Timely For Developing ResearchRandomized controlled trials should compare conservative to surgical treatment for appropriately chosen fracture patterns. Future studies should routinely report the timing of return to sport, the level of performance reached, and the time to achieve this.© The Author(s) 2022. Published by Oxford University Press.

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