More Than Fear of Reinjury – A Multidimensional Experience of Reinjury Concerns: A Systematic Review With Qualitative Evidence Synthesis of Athletes’ Experience and Interpretation of ‘Reinjury Concerns’ After Anterior Cruciate Ligament Injury

OBJECTIVE: To explore athletes’ experiences of ‘reinjury concerns’ in those with lived experience of Anterior Cruciate Ligament (ACL) injury. DESIGN: Systematic Review with Qualitative evidence synthesis. LITERATURE SEARCH: CINAHL, SPORTDiscus, Scopus, MEDLINE, PsychINFO, and ProQuest Dissertations were searched until January 2025. STUDY SELECTION CRITERIA: Two reviewers independently and in parallel screened studies for inclusion if they were: (1) Qualitative or mixed-methods; (2) included participants who were athletes with lived experience of an ACL injury; (3) reported the phenomenon of interest, ‘reinjury concerns’, within the findings; and (4) published in English. DATA SYNTHESIS: We applied thematic synthesis based on Thomas and Harden’s approach aligned to a constructivist paradigm, and followed relevant checklists for performing and reporting a systematic review and qualitative evidence synthesis. Confidence in the findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS: Forty-five studies were included, comprising 611 participants. Themes described how athletes assessed the threat of reinjury (theme one), experienced reinjury concerns across a multidimensional spectrum (theme two), and coped with reinjury concerns (theme three). Confidence in the findings was mostly rated moderate-high according to the GRADE-CERQual assessment. CONCLUSIONS: Athletes’ experiences of reinjury concerns after ACL injury were multidimensional and shaped by individual beliefs and contexts. Our findings support shifting from the narrow construct ‘ fear of reinjury’ toward a broader conceptualisation of reinjury concerns that more accurately reflects athletes’ lived experiences and may better inform assessment and clinical approaches after ACL injury.