Epidemiology of rugby injuries: a systematic review and meta-analysis

Abstract

Objective To report pooled injury incidence rates stratified by rugby format, level of play, injury outcome and sex, and to identify the most common injury sites and types. Design Systematic review and meta-analysis. Data sources Electronic databases (PubMed/MEDLINE, Web of Science and Scopus) were searched for inception to October 2024 following registration on PROSPERO. Eligibility criteria Reports reporting injury incidence per 1000 player hours in rugby were included. Pooled incidence rates with 95% CIs were estimated using a random effects model. Injuries were analysed by exposure type, anatomical location, injury type, rugby format, injury outcome and sex. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and the PRISMA checklist was utilised. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Results Across 148 reports and 8384430 player hours, 96506 rugby injuries were reported. Injury incidence was 71.6 per 1000 player hours (95%CI 38.5 to 132.9) for time-loss injuries and 138.9 (95% CI 56.8 to 339.2) for medical-attention injuries in Rugby Sevens. In Rugby League, incidence was 24.3 (95% CI 9.1 to 64.4) time loss and 61.9 (95% CI 29.9 to 127.9) medical attention per 1000 player hours. In Rugby Union, incidence was 19.9 (95% CI 14.2 to 27.7) time loss and 33.6 (95% CI 22.2 to 50.8) medical attention per 1000 player hours. Match-related injuries were consistently higher than training-related injuries across all rugby formats. Professional players demonstrated higher injury incidence than amateur players in Rugby Union and Rugby League, whereas the opposite trend was observed in Rugby Sevens. Lower limb injuries were most common, followed by head and upper limb injuries. Sprains were the most frequent injury type. Conclusion Injury incidence is high across rugby formats, particularly in Sevens, and most injuries occur during matches. Lower limb injuries and sprains predominate. Findings are limited by heterogeneity in injury definitions and study quality.