Objectives: To explore the characteristics and (2) to report on the effectiveness of postoperative rehabilitation strategies for people with an ankle fracture. Data Sources: PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL to identify studies published from January 2010 to November 2021.

Study selection: Studies that described or evaluated postoperative rehabilitation strategies for surgically repaired ankle fractures.

Data extraction: Data on postoperative rehabilitation were extracted in accordance with the Template for Intervention Description and Replication (TIDieR) guide. Quality was assessed using the National Heart, Lung and Blood Institute’s Study Quality Assessment Tools.

Data synthesis: Meta-analysis was planned to look at the effectiveness of postoperative rehabilitation strategies. Forty studies described postoperative rehabilitation strategies without evaluating effectiveness while 15 studies focused on evaluating effectiveness. Due to the large variety in postoperative strategies and outcomes, narrative synthesis was deemed most suitable to answer our aims. Characteristics of postoperative rehabilitation strategies varied widely and were poorly described in a way that could not be replicated. Most of the studies (48%) utilised a late weight-bearing approach although definitions and details around weight-bearing were unclear.

Conclusions: Late weight-bearing has been the most common postoperative approach reported in the past 10 years. The variety of definitions around weight-bearing and the lack of details of rehabilitation regimes limits replication and impacts current clinical practice. Authors propose to adopt consistent definitions and terminology around postoperative practices like weight-bearing to improve evidence for effectiveness and ultimately patient outcomes.

Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.