Objective <p>Compare neuromuscular alterations of the ankle joint between individuals with chronic ankle instability (CAI) and copers who both experienced lateral ankle sprain (LAS) to examine the functional differences and guide rehabilitation strategies.</p> Design <p>Systematic review and meta-analysis.</p> Data source <p>A comprehensive search of PubMed, Web of Science, Embase, SPORTDiscus, and Scopus databases from inception to 1 December, 2025.</p> Eligibility criteria for selecting studies <p>Observational studies and randomized controlled trials (RCTs) comparing neuromuscular function between copers and CAI patients were included.</p> Results <p>Fifteen studies including 627 participants were analyzed. Meta-analysis showed CAI individuals exhibited delayed peroneus longus (PL) latency (<i>g</i> = -1.17, 95% CI: -1.62 to -0.73), and increased tibialis anterior (TA) and medial gastrocnemius (MG) activation (<i>g</i> = -0.49 and <i>g</i> = -0.35, respectively) compared to copers. No significant differences were observed in PL activation or co-contraction indices. Muscle morphology and performance showed inconsistent outcomes across studies, preventing meta-analysis.</p> Conclusion <p>Findings from meta-analyses indicate that copers exhibit different neuromuscular functional alterations compared to individuals with CAI. However, whether these alterations are compensations in response to LAS is still unclear. Clarifying this distinction may inform understanding of CAI development and generate hypotheses for future rehabilitation research.</p> Trial registration <p>CRD42024623852. Date of Registration 19.12.2024.</p>