Context: Injury risks in professional and community rugby union have been extensively described; however, less is known about injury epidemiology at the schoolboy level.Objective: To investigate the injury risk in English schoolboy rugby union matches, comparing an elite competition (Achieving Academic and Sporting Excellence [AASE]) with subelite matches (non-AASE).Design: Retrospective cohort study. Setting: Rugby union academy, consisting of 16-to 19-year-old males, based at an elite sports college in England.Patients or Other Participants: A total of 132 participants (mean age ¼ 17.5 years) were included in the study; 64 athletes experienced a total of 103 time-loss injuries over a 3-season period (2012)(2013)(2014)(2015). All injuries were assessed and recorded by the team therapist using consensus statement definitions.Main Outcome Measure(s): Injury characteristics were recorded and compared between groups. Primary outcome measures were injury incidence (per 1000 h match exposure) and injury burden (days absent/1000 h), and rate ratios and 95% confidence intervals are presented throughout.Results: A total of 131 matches were played (34 AASE, 97 non-AASE) and a total of 103 injuries were recorded (47 AASE, 56 non-AASE). The injury incidence in AASE matches (77/1000 h) was greater than in non-AASE matches (34/1000 h). The concussion incidence in AASE matches (20/1000 h) was 5 times that of non-AASE matches (4/1000 h). The head/face had the highest injury incidence for a specific location, followed by the shoulder region (AASE ¼ 19/1000 h, non-AASE ¼ 5/1000 h), which had the greatest injury burden (553/1000 h and 105/1000 h, respectively) for any specific body location. More than 50% of all injuries were associated with tackles.Conclusions: A much greater incidence of all injuries occurred at the highest level of competition, and the concussion incidence was greater than that reported in any previously published study of youth rugby. Given the high incidence and burden of concussions and shoulder injuries, prevention and management deserve specific focus.Key Words: adolescents, injuries, youths, sport, upper limb, concussion
Key PointsPlaying in the more elite level of competition (Achieving Academic and Sporting Excellence [AASE] matches) was associated with a greater risk of injury, with an incidence rate difference of 43/1000 player-hours. The concussion incidence was 20/1000 player-hours in AASE matches, which was 5 times greater than the rate of 4/ 1000 player-hours in non-AASE matches and those in published studies of both youth and professional rugby. Shoulder injuries constituted the largest injury burden and the second highest incidence rate in the AASE group.