Ligamentous ankle injuries remain one of the most common injuries sustained by athletes. Syndesmotic, often termed high ankle, sprains are being diagnosed more frequently due to a heightened awareness and improved diagnostic techniques. These injuries result in pain, disability, and a significant delay in return to play. Most operative syndesmotic injuries can be diagnosed on plain radiographs, including stress views;​ however, ultrasound, CT, and MRI have improved the detection of more subtle injuries. Arthroscopic evaluation can be used to confirm the diagnosis while assessing other intra-articular structures. There has been an abundance of recent research exploring the treatment of syndesmotic injuries in athletes, focusing on surgical intervention and rehabilitation protocols. The literature remains conflicted regarding return to play in athletes.