More Than Fear of Reinjury - A Multidimensional Experience of Reinjury Concerns: A Systematic Review With Qualitative Evidence Synthesis of Athletes' Experience and Interpretation of "<i>Reinjury Concerns</i>" After Anterior Cruciate Ligament Injury.

Abstract

<b>OBJECTIVE:</b> To explore athletes' experiences of "reinjury concerns" in those with lived experience of anterior cruciate ligament (ACL) injury. <b>DESIGN:</b> Systematic review with qualitative evidence synthesis. <b>LITERATURE SEARCH:</b> CINAHL, SPORTDiscus, Scopus, MEDLINE, PsychINFO, and ProQuest Dissertations were searched until January 2025. <b>STUDY SELECTION CRITERIA:</b> 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. <b>DATA SYNTHESIS:</b> 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 the Evidence from Reviews of Qualitative Research (GRADE-CERQual). <b>RESULTS:</b> Forty-five studies were included, comprising 611 participants. Themes described how athletes assessed the threat of reinjury (theme 1), experienced reinjury concerns across a multidimensional spectrum (theme 2), and coped with reinjury concerns (theme 3). Confidence in the findings was mostly rated moderate-high according to the GRADE-CERQual assessment. <b>CONCLUSION:</b> 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 <i>fear of reinjury</i> toward a broader conceptualization of reinjury concerns that more accurately reflects athletes' lived experiences and may better inform assessment and clinical approaches after ACL injury. <i>J Orthop Sports Phys Ther 2026;56(3):135-157. Epub 5 February 2026. doi:10.2519/jospt.2026.13852</i>.