Advances in Augmented Reality in Sports Surgery: A Systematic Review.

Purpose: Augmented reality (AR) blends computer-generated information with the real environment to support surgical visualization, guidance, and training. In sports surgery, where arthroscopic views constrain depth perception and hand-eye coordination, AR may enhance intraoperative accuracy and efficiency and enable engaging rehabilitation. Novelty: To our knowledge, this is the first systematic review focused specifically on AR across the sports surgery continuum (operative and rehabilitative), synthesizing visualization modalities, use cases, and measured outcomes to identify translational gaps. Methods: We searched MEDLINE (PubMed), Embase, Scopus, and Web of Science (January 2024), registered the protocol on PROSPERO (CRD42024543974), and reported according to PRISMA 2020. Eligibility included preclinical and clinical studies using AR/MR in sports-orthopedic contexts. Risk of bias was assessed using RoB 2 (RCTs), ROBINS-I (nonrandomized studies), and NIH tools for other designs. Qualitative synthesis was structured by AR type, surgical indication/use case, and outcome domain. Results and Findings: Twenty-one articles met the criteria. Sixteen assessed intraoperative applications and four rehabilitation, with knee arthroscopy being the most common. Comparative human studies reported more accurate femoral tunnel placement in ACL reconstruction and shorter operative time in selected workflows, while several studies showed feasibility in simulators/cadavers. Video see-through (VST) and optical see-through (OST) (e.g., HoloLens) were most frequently used. Conclusions: AR shows early promise for guidance, training/telementoring, and postoperative rehabilitation in sports surgery, but current evidence is heterogeneous and often feasibility-focused. Larger, controlled clinical trials with standardized outcome definitions and reporting are needed to confirm benefits, evaluate learning curves and ergonomics, and support integration into operating room workflows.