Background: Although syndesmosis sprains are less common in sports than lateral ankle sprains, they represent a significant source of morbidity. Several studies have described the increased recovery time for these injuries in a variety of sports. No previous study has described this injury in hockey players. Hypothesis: Syndesmosis ankle sprains require a longer recovery time and are less common than lateral ankle sprains in elite hockey players. Study Design: Uncontrolled retrospective review. Methods: The medical records of the St Louis Blues (1994-2001) and Dallas Stars (1991-2001) National Hockey League teams were reviewed by the head athletic trainers. Ankle sprains were identified and divided into 2 groups: syndesmosis and lateral sprains. Player demographics, treatment, and time lost to play were recorded for each injury. Results: Fourteen players were diagnosed with syndesmosis sprains, and 5 players sustained lateral sprains during this time period. Mean time to return to play in games was 45 days (range, 6-137 days) for syndesmosis sprains versus 1.4 days (range, 0-6 days) for lateral sprains. Conclusions: Syndesmosis sprains represent a significant injury in hockey players with an extended time lost and, unlike in other sports, are a more common injury than lateral ankle sprains.