Doctor, I fractured my ankle. When can I return to play? An updated systematic review

INTRODUCTION: Ankle 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 DATA: We 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 AGREEMENT: Thirteen 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 CONTROVERSY: The 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 POINTS: Conservative management for stable or undisplaced fracture may result in a higher proportion of patients returning to sport more quickly. AREAS TIMELY FOR DEVELOPING RESEARCH: Randomized 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.