Between 2008 and 2022, Lower-Extremity Injuries Declined in Male Rugby Players, Whereas Noncontact Knee Injuries Showed No Decline in Female Rugby Players

Abstract

Purpose

To assess the distribution and mechanisms of lower-extremity injuries among high school and college age rugby players presenting to U.S. emergency departments (EDs) from 2008 to 2022.

Methods

The National Electronic Injury Surveillance System was queried for lower-extremity rugby injuries (ages 14-23 years) from January 2008 to December 2022. Patient demographics, injury location, diagnosis, and disposition were extracted for each case. Linear regression analysis assessed differences over time. Injury distribution for male versus female players was evaluated using Pearson χ² analysis.

Results

An estimated 31,318 (845 National Electronic Injury Surveillance System cases) high school and college-age rugby players presented to U.S. EDs with a lower-extremity injury during the study period. Male players accounted for 66.9% of the injuries. Linear regression analysis revealed a significant decrease in the annual frequency of lower-extremity injuries presenting to U.S. EDs from 2008 to 2022 (P = .001). The most common injury mechanism was overwhelmingly a noncontact twisting motion (11,108, 35.5%) followed by a hit/collision (5,298, 16.9%). Strains/sprains were the most common diagnosis (17,243, 55.1%). Injuries most commonly occurred at the ankle (12,659, 40.4%) and knee (11,016, 35.2%). In a sex-specific linear regression analysis, there was a significant decrease in lower-extremity injuries sustained by male players (P = .001) but no significant decrease among female players (P = .112). Furthermore, χ² analysis revealed that female players sustained a significantly greater proportion of knee injuries secondary to twists (15.9% for female vs 9.0% for male players, P = .01).

Conclusions

Lower-extremity injuries are declining among high school and college-age male rugby players. However, there has not been a corresponding decrease among female rugby players. Furthermore, female players are disproportionately affected by noncontact twisting knee injuries.

Level of Evidence

Level III, retrospective comparative study.