Biomechanical Assessment Tools for Injury Risk Prediction and Return-to-Sport Evaluation in Athletes: A Systematic Review

TL;DR

This review examines biomechanical tools used to assess injury risk and readiness to return to sports after ACL injuries, finding that combining multiple metrics improves accuracy.

Contribution

The study systematically evaluates the predictive validity and clinical utility of biomechanical tools across diverse athletic populations.

Findings

Reduced quadriceps strength symmetry and compensatory kinematic deviations are linked to unsafe return-to-sport.

Proprietary force-plate scores like Sparta Science metrics have limited predictive value without multifactorial frameworks.

Sagittal-plane metrics show high reliability, while coronal and transverse measures are less consistent.

Abstract

Anterior cruciate ligament (ACL) injuries, particularly non-contact types, remain a major concern for athletes. Biomechanical screening tools such as 3D motion capture and force plates have advanced risk assessment and return-to-sport evaluation, yet their predictive validity and clinical applicability across diverse athletic populations remain unclear. This systematic review, conducted in accordance with PRISMA 2020 guidelines, searched four databases (PubMed, Cochrane Library, Scopus, Web of Science) up to July 25, 2025, and included original studies assessing athletes with biomechanical tools for injury risk or return-to-sport readiness. Of 4,787 records identified, eight studies met the criteria. Most utilized motion analysis or force plates to evaluate landing kinematics, limb symmetry, and postural control. Key findings showed that reduced quadriceps strength symmetry, psychological unreadiness, and compensatory kinematic deviations were strongly associated with delayed or unsafe return-to-sport. While sagittal-plane metrics demonstrated high reliability, coronal and transverse measures were less consistent, and proprietary force-plate scores, such as Sparta Science metrics, showed limited predictive value unless used within multifactorial frameworks. Overall, biomechanical assessments provide meaningful insights into injury risk and rehabilitation progress, particularly when emphasizing strength symmetry and kinematic consistency, but reliance on single metrics or composite scores without contextual interpretation may restrict clinical utility. Future research should focus on longitudinal designs and standardized protocols to enhance predictive accuracy.

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