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Return to sport following lateral ankle ligament repair is under-reported: a systematic review
  1. Kenneth J Hunt1,
  2. Richard S Fuld III1,
  3. Brittan S Sutphin1,
  4. Helder Pereira2,
  5. Pieter D’Hooghe3
  1. 1 Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
  2. 2 Department of Orthopaedic Surgery, Centro Hospitalar Póvoa de Varzim-Vila do Conde, ICVS-3Bs Associated Laboratory Minho University. Ripoll y DePrado Sports Clinic., Póvoa de Varzim, Portugal
  3. 3 Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Kenneth J Hunt, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO 80045, USA; kenneth.j.hunt{at}


Importance Ankle sprains are the most commonly occurring musculoskeletal injury. Reconstruction of the lateral ligament complex is often required for athletes with recurrent instability, or high-grade acute sprains, in order to return to their pre-injury level of sport.

Objective The purpose of this systematic review was to evaluate the spectrum, prevalence and quality of evidence regarding return to sport timeline following lateral ligament surgery.

Evidence review A search was conducted of Embase and Medline databases from the earliest possible entry to November 2016. Studies reporting a timeline regarding return to play (RTP) following lateral ankle ligament reconstruction were included in this review.

Findings Of 3184 total articles, 20 articles evaluating 489 athletes met the criteria and were included for review. Thirteen of the 20 papers were used to calculate a weighted mean time to RTP of 4.7 months. Overall, both the frequency and quality of RTP criteria and reporting were very low.

Conclusions and relevance The current review identifies a clear deficiency in the literature pertaining to consistent, meaningful postoperative RTP timeline following lateral ankle ligament repair. Published studies vary considerably in the metrics used for measuring patient-reported outcomes, and very few actually track them. Further studies on outcomes following ankle ligament repair should include clear and consistent metrics for return to sport and level of play. Standardised and reproducible criteria for reporting RTP for athletes will improve the utility and applicability of outcomes data as surgical and rehabilitative techniques continue to advance.

Level of evidence Systematic review of level I–IV studies, level IV.

  • Ankle
  • Instability
  • Sprain
  • Ligament
  • Repair / Reconstruction
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  • Contributors KJH was responsible for study design, data analysis, manuscript preparation and revision, and overseeing the project. RSF and BSS contributed to the review of the literature, data abstraction and writing of the manuscript. HP and PD contributed to study design, and manuscript preparation and revision.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement There are no unpublished data from this study.

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