Objective:To categorize injury types and occurrence among athletes participating in the Special Olympics (SO).Design:Retrospective cross-sectional cohort study.Setting:2018 SO USA Games.Participants:Athletes participating in 14 sports at the 2018 SO USA Games (n = 2251).Independent Variables:Individual and team sports.Main Outcome Measures:Percentage of athletes injured per individual sport, percentage of injury type by sport, rate of injuries per 1000 exposures, and number of injuries per game in team sports.Results:In individual sports, the percentage of athletes injured ranged from 38.5% in gymnastics to 12.9% in golf. Musculoskeletal (MSK) injuries occurred in 53.3% of gymnastics injuries and 58.6% of tennis injuries. For stand-up paddleboard, most injuries were non-MSK (66.7%). The highest rate of MSK injuries occurred in gymnastics (25.6/1000 exposures), whereas the highest rates of non-MSK injuries (95.2/1000 exposures) and minor injuries (47.6/1000 exposures) were among stand-up paddleboard athletes. In team sports, the highest number of injuries per game occurred in softball (1.9 per game).Conclusions:A high percentage of injuries occurred at the 2018 SO USA Games. The high rate of non-MSK injuries is unique to the SO and should be considered when planning medical coverage for future events.