Return to sport after surgical treatment of chronic lateral ankle instability: a proposed, expert-informed criteria-based clinical framework

Chronic lateral ankle instability may limit return to running, jumping and multidirectional sport even after surgery restores mechanical stability. Return-to-sport decisions often rely on elapsed time, while definitions and clearance criteria vary. This structured narrative review examines return to sport after lateral ankle ligament repair or reconstruction and proposes an unvalidated, expert-informed clinical framework. MEDLINE/PubMed, Scopus and Web of Science were searched to 31 August 2026, with a targeted PubMed update on 6 October 2026. Recent pooled evidence indicates that approximately 95% of patients return to any sport and 83% return to their preinjury level, although definitions and procedures are heterogeneous. Postoperative studies of the Ankle-GO battery provide emerging support for multidomain assessment, but samples are small and prognostic thresholds remain uncertain. We propose five gates: protection and clinical quietness; foundational capacity; running and plyometric competence; sport integration; and graded competition followed by sustained performance. The Pain, Ankle impairments, Athlete perception, Sensorimotor control and Sport/functional performance (PAASS) domains are integrated with operative restrictions, procedure-specific healing and progressive sport exposure. Numerical targets and timelines are illustrative, not validated clearance rules. Progression requires surgeon approval, acceptable symptoms, functional competence, psychological readiness and tolerance of relevant training. Passing an assessment supports a clearance decision but does not demonstrate future safety or sustained performance. Prospective evaluation of feasibility, reliability and prognostic accuracy is required before this framework can be recommended as a standardised pathway.