The Hidden Cost of Sports Injuries: A Medico-Legal Perspective on Performance, Career and Contracts

The medico-legal assessment of sports injuries in professional athletes continues to rely on tools designed for an entirely different context. Permanent impairment tables measure the reduction in overall individual function, but not the loss of competitive performance, the reduction in expected athletic lifespan, or the impact on contracts and earnings. In this Editorial we argue that closing this gap does not require new, ad hoc composite indices, but a more rigorous and systematic integration of approaches already validated in the sports medicine and rehabilitation literature: objective quantification of the return-to-sport (RTS) deficit, obtained by comparing validated sport-specific functional and performance outcome measures recorded before and after injury; structured documentation of the rehabilitation pathway, including objective RTS criteria, time-to-RTS, and the psychological readiness to compete; and an evidence-based estimate of the economic and contractual impact, grounded in objective performance-analytics data rather than presumptive percentages. The integration of these indices with clinical-orthopaedic assessment may allow a more accurate definition of "functional-professional" damage in athletes, with significant implications for insurance, legal, and medico-legal practice. The aim is to promote a new multidisciplinary assessment model capable of bridging the traditional distinction between biological damage and economic loss, providing a more realistic and equitable measure of the consequences of sports trauma on athletes' careers.