Background:​ Ankle sprains are very common injuries among athletic populations. Sparse data exists regarding return to play (RTP) following common lateral ligament repairs. Our purpose is to compare RTP timelines and outcomes between open and arthroscopic treatment of lateral ankle instability in athletes.

Methods:​ In this systematic review, MEDLINE and EMBASE searches were performed to identify available literature through November 2017 describing open and/or arthroscopic treatment of lateral ankle instability in athletes, their outcomes, and a RTP timeline.

Results:​ A total of ten studies met criteria. 174 athletes were treated with open ankle instability procedures (9 studies) and 19 athletes were treated with arthroscopic procedures (1 study). 167/174 patients with open treatment returned to sport (96% RTP rate, weighted mean RTP timeline of 2.85 months). In comparison, all 19 patients in the arthroscopic group returned to sport (100% RTP rate, weighted mean RTP timeline of 3.794 months).

Conclusion:​ Very few articles describing outcomes of lateral ligament repair in athletes include return to play metrics. Considering the data available, athletes treated with open ankle ligament repair procedures (nine studies with 167 athletes) returned to play almost 1 month earlier than athletes treated with arthroscopic procedures (1 study with 19 athletes). As timing of return to activities is a valuable metric to compare surgical and rehabilitative techniques, more studies that detail return to sport are needed as part of a description of ankle ligament repairs.