The Role of Psychosocial Factors in Returning to Physical Activity and Sport Among Female Football Players After Anterior Cruciate Ligament Injury: A Scoping Review.

backgroundAnterior cruciate ligament (ACL) injuries are an increasingly common knee injury in sport requiring quick direction changes, such as the football codes. Return to physical activity and sport following an ACL injury predominantly focuses on achieving objective milestones to resolve physical impairments, with sex differences reported. However, irrespective of management approach following an ACL injury, many athletes do not return to the same level of sport, if at all, warranting the need to consider psychological and social factors.

aimThe aim of this scoping review was to investigate the role of psychosocial factors in females participating in any football code after an ACL injury, and the impact on return to physical activity and sport.

methodsA systematic search of six electronic databases (SCOPUS, CINAHL, MEDLINE, SPORTDiscus, PsycInfo, and Embase) was conducted on 1 May 2025. Two reviewers independently screened articles against the eligibility criteria to include original research articles that explored the impact of psychosocial factors on return to sport (RTS) or physical activity in females playing any football code with an ACL injury managed surgically or non-surgically. Studies were eligible where participants had a mean age of 18 years or older. Data extraction and narrative synthesis of included studies was undertaken and themes identified to address the research aim.

resultsFull-text articles (n = 74) were assessed for eligibility following screening of titles and abstracts (n = 582); seven eligible studies were included. Across the studies, psychosocial barriers and facilitators were perceived to influence RTS at either preinjury or lower competition levels, as well as physical activity, in female footballers. Uncertainty, fear, lack of confidence, and poor social support were identified as perceived barriers to RTS contributing to return at a lower level of competition and the alteration, limitation, or avoidance of physical activity among female footballers. Whilst confidence, motivation, strong social support and athletic identity were identified as perceived facilitators of RTS, helping to build readiness and supporting female footballers to return at their preinjury level or a lower level of competition.

conclusionPsychosocial factors appear to play an important role in RTS and physical activity following ACL injury in female football players, acting as both barriers and facilitators to recovery. Further high-quality research focussed specifically on female footballers is needed to better understand these relationships and inform targeted screening and interventions.