Return to performance criteria in soccer after musculoskeletal injury: A scoping review.

Abstract

Return to performance (RTPe), the final stage of the return to sport (RTS) continuum remains poorly defined in current soccer-related musculoskeletal (MSK) research, with limited identification and application of physical and/or psychological performance-based indicators. This scoping review aimed to systematically identify and synthesise currently used RTPe criteria, with a specific focus on facilitating return to competitive soccer at the same or higher level than pre-injury and identify gaps in relation to sport-specific demands. A scoping review was conducted in accordance with the PRISMA-ScR guidelines, using comprehensive Boolean search strategies across PubMed, CINAHL, and Web of Science databases. A total of twenty-nine peer reviewed studies met the inclusion criteria. Reported RTPe criteria encompassed the following domains: clinical examination, strength assessment, functional testing, performance-based testing, time elapsed since injury, and patient-reported outcome measures (PROMs). Most studies concentrated on the second stage of the three-stage RTS continuum, that is, 'Return to Sports', with limited integration of on-field, sport specific, or ecologically valid performance assessments. In addition, studies frequently neglect recommendations advocating a multidimensional and standardised test battery. Moreover, psychological readiness and performance-level demands-critical components of RTPe in elite soccer-were seldom addressed or often lacked standardised definitions. Female athletes were underrepresented despite higher injury incidence (6.77 vs. 5.70/1000 h in males). Anterior cruciate ligament (ACL) injuries were overrepresented, whereas more frequently occurring injuries like posterior thigh and groin injuries received less attention. More than half of the studies focused on elite athletes, limiting generalisability to recreational level. These findings underscore the urgent need for more robust, operationalized, and sport-specific RTPe criteria to support clinical decision-making and optimise outcomes following musculoskeletal injury in soccer. Existing criteria do not reliably capture readiness to pre-injury performance levels, addressing performance metrics, sport specific demands, and sex-specific considerations. Level of Evidence: N/A.