ObjectiveTo determine the emotional and cognitive impact of injury and surgery on physical recovery in injured athletes.DesignA prospective longitudinal study comparing the psychosocial and physical recovery of competitive and recreational athletes.SettingTertiary-care sports medicine center.ParticipantsTwenty-seven athletes (15 men and 12 women) who required anterior cruciate ligament (ACL) reconstruction surgery.InterventionsA repeated-measures design used to compare the psychosocial and physical changes for 6 months after ACL surgery.Main Outcome MeasuresEmotional (mood) and cognitive (coping) functions and physical recovery (range of motion, physician-rated level of recovery, and physician permission to return to sport).ResultsThere was a significant time-effect difference in mood, with a greater mood disturbance and recovery rate for competitive athletes than recreational athletes. Differences in mood and pain coping were significant at 2 weeks and 2 months after surgery.ConclusionAthletes experience significant mood changes throughout rehabilitation, which may hinder rehabilitation early in the process. Longer-term rehabilitation was not impacted by mood or pain coping. Future studies might focus on examining the process over a longer time period (1–2 years after surgery). Physicians should be aware of these findings and appropriately counsel and motivate athletes toward more favorable positive psychological and physical outcomes.