Return-to-sport rate and time in elite athletes after ankle syndesmosis injuries: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Ankle syndesmosis injuries are a significant concern in elite athletes, often resulting in prolonged recovery and uncertainty regarding optimal management. Although most athletes eventually return to sport (RTS), reported RTS rates and timelines vary widely due to differences in treatment strategies. Given this heterogeneity and lack of consensus, this study systematically reviews RTS rates and time to RTS in elite athletes following syndesmotic ankle injuries. METHODS: A systematic search of five databases was performed through September 2025 to identify studies on RTS outcomes in elite athletes with ankle syndesmosis injuries. Pooled RTS proportions were calculated using a random-effects model with logit transformation, and time outcomes were synthesized using random-effects models or descriptive methods. Subgroup, sensitivity, and meta-regression analyses were conducted to assess heterogeneity. Study quality was evaluated using the Newcastle-Ottawa Scale, and publication bias was assessed with funnel plots and Egger's test. RESULTS: = 27%). Subgroup analysis showed comparable RTS rates for suture-button fixation (98%) and nonoperative management (98%). Sensitivity analyses confirmed the robustness of the findings. Publication bias was suggested by funnel plot asymmetry and Egger's test (p = 0.0002). The average time to RTS across studies was approximately 58 days. CONCLUSION: Elite athletes sustaining ankle syndesmosis injuries demonstrate a high likelihood of returning to sport, with a pooled RTS rate of 96%. Comparable outcomes were observed following both suture-button fixation and nonoperative management, with most athletes resuming play within 2 months. Most athletes can anticipate favorable outcomes regardless of treatment strategy, though management should still be individualized based on injury severity and sport-specific demands.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.050 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.040 |
| Bibliometrics | 0.010 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".