Abstract

The association between return-to-sport test batteries (RTS-TBs) and clinical outcomes remains unclear. Previous systematic reviews of RTS-TBs have reported low pass rates; however, these reviews have been limited by substantial heterogeneity. This systematic review aimed to quantify RTS-TB pass rates and examine their association with timing (post-op). Five electronic databases (AMED, CINAHL, MEDLINE, SPORTDiscus, PubMed) were searched on 22 December 2024. Observational studies reporting RTS-TB outcomes as a single pass or fail were included. A random-effects proportion meta-analysis was used to estimate the pooled prevalence of pass rates. A meta-regression was performed to assess the association between test timing and pass rate. Twelve studies (n = 1977) met the eligibility criteria, but five were excluded from the meta-analysis and meta-regression due to overlapping cohorts. From the remaining eight studies (n = 1449), the pooled prevalence of pass rates was 33% overall (95% CI 19 to 47%), 26% (95% CI 18 to 33%) for non-professional athletes, and 73% (95% CI 66 to 80%) for professional athletes, although only a single study focused on professional athletes. No association was observed between the post-operative timing of the test and passing RTS-TB (p = 0.73). The observed RTS-TB pass rates are low, and this may be influenced by the extreme heterogeneity. Although no association was observed between the RTS-TB timing and pass rates, this finding alone cannot confirm causality.