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Studies reporting RTP criteria for hamstring, adductor, quadriceps, and calf injuries, as well as general criteria for all muscle injuries, were included. The certainty of evidence for RTP criteria was assessed on the basis of the studies citing each criterion.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Out of 58,057 records, 135 studies met the inclusion criteria. Strength and pain criteria are the most cited tests for determining RTP clearance following hamstring injuries, particularly criteria related to between-limb knee flexors\/extensors strength symmetry and no pain during soccer-specific actions. Range of motion criteria (active knee extension, passive and active straight leg raise, and Askling-H tests) and subjective readiness demonstrated the highest certainty of evidence in RTP decision making after hamstring injuries. RTP criteria following adductor injuries showed a moderate-to-very-low certainty of evidence across domains. Criteria for quadriceps and calf injuries ranged from low to very low evidence, while general lower limb muscle injury criteria had only very low evidence. Following adductor injuries, the highest evidence (moderate) was shown by pain assessments and completing at least one full team training session.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Symmetry between limbs in knee flexor and extensor strength combined with no pain during soccer-specific actions were the most frequently implemented RTP criteria for hamstring injuries. In addition, range of motion evaluation (i.e., active knee extension, passive and active straight leg raise, and Askling-\n H<\/jats:italic>\n tests) and subjective readiness assessments have been more consistently employed in higher-quality intervention studies than other domains following hamstring injuries in soccer players. Pain assessments, completing at least one full team training session and restoring strength levels are the most cited criteria for RTP following adductor injuries. The evidence base describing RTP criteria for quadriceps and calf injuries is limited and is not implemented in randomized controlled trials with high methodological quality, highlighting the need for further robust research in these domains.\n <\/jats:p>\n <\/jats:sec>\n \n Trial Registration Number<\/jats:title>\n PROSPERO CRD42022363836.<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s40279-026-02404-9","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T19:35:36Z","timestamp":1773862536000},"page":"1433-1465","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Return-to-Play Criteria Following Lower Limb Muscle Injuries in Soccer: A Systematic Review with Evidence Synthesis"],"prefix":"10.1007","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2842-3067","authenticated-orcid":false,"given":"Javier","family":"Pecci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0724-5997","authenticated-orcid":false,"given":"Nicol","family":"van Dyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9983-8422","authenticated-orcid":false,"given":"Gregory D.","family":"Myer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9969-9573","authenticated-orcid":false,"given":"Borja","family":"Sa\u00f1udo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2404_CR1","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1136\/bjsports-2020-103159","volume":"55","author":"J Ekstrand","year":"2021","unstructured":"Ekstrand J, Spreco A, Bengtsson H, Bahr R. 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Myer consults with commercial entities to support commercialization strategies and applications to the US Food and Drug Administration but has no direct financial interest in the commercialization of the products. Dr. Myer\u2019s institution receives current and ongoing grant funding from National Institutes of Health\/NIAMS (U01AR067997, R01AR070474, R01AR055563, R01AR076153, R01AR077248, R61AT012421), Department of Defense (W81XWH22C0062), and Arthritis Foundation (OACTN). Dr. Myer has received industry-sponsored research funding to his institutions related to injury prevention and sport performance and has current ongoing funding from Arthrex Inc. to evaluate ACL surgical treatment optimization strategies. Dr. Myer receives author royalties from Human Kinetics and Wolters Kluwer. Dr. Myer is an inventor of biofeedback technologies (patent no. US11350854B2, Augmented and Virtual Reality for Sport Performance and Injury Prevention Application, approval date: 6 July 2022, software copyrighted), designed to enhance rehabilitation and prevent injuries. Dr. Myer receives inventor-related royalties from biofeedback technologies (Include Health: LIC1907082014-0706).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient Involvement"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All data relevant to the study are included in the article or are available as supplementary files.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data Sharing"}},{"value":"J.P., N.V.D., G.D.M. and B.S. conceptualized the study; J.P. and B.S. were involved in the data curation and investigation process; J.P., N.V.D., G.D.M. and B.S. contributed to the methodology and the project administration of the study, as well as to the resources; J.P. and B.S. were involved in the software part for the present study; B.S. supervised the study; N.V.D. and G.D.M. were responsible for the validation of the study; J.P. was responsible for the visualization part of the study, creating figures and visual material and also wrote the original draft; N.V.D., G.D.M. and B.S. reviewed and edited the final draft.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author Contributions"}}]}}