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 the 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 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. CONCLUSION: 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 conceptualization of reinjury concerns that more accurately reflects athletes' lived experiences and may better inform assessment and clinical approaches after ACL injury. J Orthop Sports Phys Ther 2026;56(3):135-157. Epub 5 February 2026. doi:10.2519/jospt.2026.13852