Artificial Intelligence in Sports Medicine: A Decision-Centered Framework for the Future Sports Physician

Background: Artificial intelligence (AI) is rapidly transforming healthcare, with increasing applications in sports medicine. Advances in machine learning, deep learning, and computer vision enable the analysis of large, heterogeneous datasets derived from imaging, wearable sensors, performance-monitoring systems, and electronic health records. While these technologies offer opportunities to enhance injury prevention, diagnostic accuracy, rehabilitation monitoring, and clinical decision-making, their integration into athlete care remains complex and context-dependent. Methods: A structured narrative review of the PubMed/MEDLINE database was conducted to identify clinically relevant AI applications in sports medicine. The search focused on key domains including injury risk prediction, musculoskeletal imaging, rehabilitation monitoring, return-to-play assessment, performance management, and clinical workflow support. Evidence from original studies, reviews, methodological reports, and regulatory documents was qualitatively synthesized to provide an overview of current applications, methodological limitations, and decision-level implications. Results: AI demonstrates growing utility across multiple domains of sports medicine. Machine learning models can identify complex, non-linear relationships among training load, physiological responses, and injury risk, though their predictive performance varies widely and is often limited by dataset heterogeneity and a lack of external validation. In musculoskeletal imaging, AI-based algorithms support automated detection and quantification of abnormalities, with performance in selected tasks approaching that of expert readers, yet remaining task-specific and context-dependent. Emerging applications include movement analysis and rehabilitation monitoring through wearable sensors and computer vision systems, as well as data-driven support for return-to-play decisions and clinical workflow optimization. However, current evidence highlights important limitations, including algorithmic bias, limited generalizability, poor interpretability, and the risk of misapplication in complex clinical decision-making contexts. Conclusions: AI is likely to become an important decision-support layer in sports medicine by enabling data integration and longitudinal monitoring. However, model performance does not necessarily translate into improved clinical outcomes, and AI-generated predictions remain probabilistic and context-sensitive. Consequently, clinical decisions-particularly high-stakes processes such as return-to-play-require structured integration of AI outputs within a broader clinical framework. The sports physician remains central as a human-in-the-loop integrator, responsible for contextualizing AI-derived information, mitigating potential errors, and ensuring safe, individualized athlete management.