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Objective To determine the frequency and diagnostic utility of visible signs identified through video review for sport-related concussion detection and to evaluate the role of injury mechanism in predicting concussions.Design Systematic review.Data sources MEDLINE, SPORTDiscus, Web of Science and Cochrane Library from 2001 to June 2024.Eligibility criteria Original, peer-reviewed studies focusing on sport-related concussion, where video review identified visible signs or the mechanism of injury relevant to clinical decision-making. Studies were included irrespective of study design but had to be published in English and use a clinical diagnosis or consensus definition of sport-related concussion as a reference standard.Results Out of 1001 records screened, 29 studies involving 3281 sport-related concussions were included for quantitative synthesis. Only eight studies had a low risk of bias. All studies used clinical diagnosis as a reference standard; 26 were conducted in professional competitions, with two studies including female athletes. The most frequently observed visible sign was ‘slow to get up’ (37.6%), followed by ‘motor incoordination’ (26.7%). Sensitivity of visible signs was generally low (<50%), while specificity was high (>90%) across most studies. Four studies across three sports examined mechanism of injury characteristics, identifying common themes, such as high speed of impact, potentially associated with sport-related concussion occurrence. Inter-rater and intrarater reliability varied, with indications of higher reliability among expert raters.Conclusions Expert video review can reliably identify visible signs of sport-related concussion. However, due to their low frequency and limited diagnostic sensitivity, the diagnosis of sport-related concussion should be supported by a multimodal assessment.