Study Design Systematic review and meta-analysis. Objectives To compare early ankle movement versus ankle immobilization after surgery for ankle fracture on clinical and patient-reported outcomes. Background A significant proportion of patients undergoing surgery for ankle fracture experience postoperative complications and delayed return to function. The risks and benefits of movement of the ankle in the first 6 weeks after surgery are not known, and clinical practice varies widely. Methods We searched bibliographic databases and reference lists to identify eligible trials. Two independent reviewers conducted data extraction and risk of bias assessments. Results Fourteen trials (705 participants) were included in the review, of which 11 trials were included in the meta-analysis. Quality of trials was universally poor. The pooled effect of early ankle movement on function at 9-12 weeks after surgery compared to immobilization was inconclusive (Standardized Mean Difference (SMD) 0.46, 95% CI -0.02 to 0.93, P=.06, I(2)=72%), and no differences were observed between groups at 1 year. The odds of thrombosis/embolism was significantly lower with early ankle movement compared to immobilization (Peto odds ratio [OR] 0.12 95% CI 0.02 to 0.71, P=.02, I(2)=0%). Deep surgical site infection (SSI) (Peto OR 7.08 95% CI 1.39 to 35.99, P=.02, I(2)=0%), superficial SSI, fixation failure, and reoperation to remove metalwork were more common after early ankle movement compared to immobilization. Conclusion The quality of evidence is poor. The effects of early movement after ankle surgery on short-term functional outcomes are unclear, but there is no observable difference in the longer term. There is a small reduction in risk of postoperative thrombosis/embolism with early ankle movement. Current evidence suggests that deep and superficial SSIs, fixation failure, and need for removal of metal work are more common after early ankle movement. Level of Evidence Therapy, level 1a-. J Orthop Sports Phys Ther, Epub 6 August 2014. doi:10.2519/jospt.2014.5294.