Ethical Bias in AI-Driven Injury Prediction in Sport: A Narrative Review of Athlete Health Data, Autonomy and Governance

The increasing use of artificial intelligence (AI) in athlete health monitoring and injury prediction presents both technological opportunities and complex ethical challenges. This narrative review critically examines 24 empirical and conceptual studies focused on AI-driven injury forecasting systems across diverse sports disciplines, including professional, collegiate, youth, and Paralympic contexts. Applying an IMRAD framework, the analysis identifies five dominant ethical concerns: privacy and data protection, algorithmic fairness, informed consent, athlete autonomy, and long-term data governance. While studies commonly report the effectiveness of AI models—such as those employing decision trees, neural networks, and explainability tools like SHAP and HiPrCAM—few offers robust ethical safeguards or athlete-centered governance structures. Power asymmetries persist between athletes and institutions, with limited recognition of data ownership, transparency, and the right to contest predictive outputs. The findings highlight that ethical risks vary by sport type and competitive level, underscoring the need for sport-specific frameworks. Recommendations include establishing enforceable data rights, participatory oversight mechanisms, and regulatory protections to ensure that AI systems align with principles of fairness, transparency, and athlete agency. Without such frameworks, the integration of AI in sports medicine risks reinforcing structural inequalities and undermining the autonomy of those it intends to support.