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To determine the emotional and cognitive impact of injury and surgery on physical recovery in injured athletes.A prospective longitudinal study comparing the psychosocial and physical recovery of competitive and recreational athletes.Tertiary-care sports medicine center.Twenty-seven athletes (15 men and 12 women) who required anterior cruciate ligament (ACL) reconstruction surgery.A repeated-measures design used to compare the psychosocial and physical changes for 6 months after ACL surgery.Emotional (mood) and cognitive (coping) functions and physical recovery (range of motion, physician-rated level of recovery, and physician permission to return to sport).There 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.Athletes 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.