Psychosocial predictors of return to sport after sports injury: A systematic review

The search for elite performance, and more demanding competitive schedules, compel athletes to make significant sacrifices and to sustain high levels of physical endurance during arduous training sessions and tournaments. These demands may surpass the physiological adaptation capacities of the athlete, diminish focus and raise the risk of reckless movements. Consequently, sports injuries are common and can have serious ramifications for an athlete’s health, athletic performance, and future sporting career. The full functional recovery and effective RTS, defined as the resumption of training and competitive activities at the level obtained before injury (Ardern et al., 2016), are among the primary goals of sports injury treatment and rehabilitation. Traditionally, RTS decisions have been mostly driven by the assessment of physical healing and functional performance. Nevertheless, multiple studies have demonstrated that a significant minority of athletes do not return to their preinjury level of sport engagement, despite adequate functional recovery and meeting the criteria for medical clearance. In an updated systematic review, Ardern et al. (2014) found that 81% of athletes returned to some type of sport involvement following anterior cruciate ligament reconstruction (ACLR), 65% returned to their preinjury sport and just 55% returned to competitive sport. Webster and Feller (2019) observed similar results, with 82% of patients returning to some sort of athletic involvement, 63% returning to their preinjury sport, and just 44% returning to competitive activity following ACLR. These return rates differed from functional outcomes, with about 90% of patients achieving normal or near-normal functional performance. The results of these studies clearly indicate that effective RTS depends not only on physical recovery but also on the athlete's psychological readiness. Following these findings, research on the involvement of psychological elements in the RTS process has grown substantially. Psychological readiness has been identified as a key component of athlete recovery in contemporary literature reviews (Longo et al., 2023; Nedder et al., 2025) and not addressing this aspect may have detrimental consequences on RTS results and increase the chance of reinjury.

Mechanisms of sports injuries, principles of operative and non-operative treatment, rehabilitation procedures, and outcome assessment are detailed in professional and scientific literature. However, the significance of predictors of the injured athlete's mental state during the recovery phase is still not fully clarified. Numerous differences present in the type of sport and injuries, the injured segment, the observed study population, as well as the lack of standardized measuring instruments for evaluating the impact of psychological variables on injured athletes, contribute to the heterogeneity of previous findings. From these statements emerges the primary goal of this study – the recognition, clinical analysis, and summarizing of available information about psychological and psychosocial aspects associated with RTS after sports injuries.

Methods

This section outlines the systematic framework used to identify, select, and analyze the scientific literature regarding psychological outcomes in athletes. It details the precise search protocols, eligibility criteria, and data synthesis methods applied throughout the entire review process.

Study design

This section outlines the systematic framework used to identify, select, and analyze the scientific literature regarding psychological outcomes in athletes, detailing the precise search protocols, eligibility criteria, and data synthesis methods applied. This comprehensive procedural structure serves to ensure that all selected data are evaluated with the highest level of methodological consistency.