Epidemiology of Subsequent and Recurrent Injuries in Rugby: A Systematic Review

To review and collate epidemiological data on recurrent and subsequent injuries in male rugby and identify risk factors such as injury type. Four databases were searched from January 1, 1974 through October 1, 2020. Keywords were:((“Football”[Mesh]) OR (rugby)) AND ((recurrent injury) OR (subsequent injury)) in PubMed, (‘rugby’/exp OR rugby) AND (recurrent AND (‘injury’/exp OR injury) OR subsequent) AND (‘injury’/exp OR injury) in Embase, rugby AND (subsequent injury OR recurrent injury) in CINAHL Plus, and TOPIC: (rugby) AND TOPIC: (subsequent injur* OR recurrent injur*) in Web of Science. Inclusion Criteria:(i) population consisted of male rugby players; (ii) used “time-loss” as an injury definition; (iii) included extractable data on both subsequent injury count and recurrent injury count; (iv) written in English. 6/1242 studies met criteria for inclusion. Quality was assessed using STROBE guidelines. Studies using “missed-match” as a definition of time-loss showed no difference in incidence of subsequent versus recurrent injuries. Studies using “24-hour time-loss” as the definition of injury reported 7,724 (71%) subsequent injuries (95% CI: 0.71–0.72) and 1,434 (14%) recurrent injuries (95% CI: 0.13–0.15). In pediatric players, 98 (23%) were subsequent (95% CI: 0.19–0.27) and 21 (5%) were recurrent (95% CI: 0.03–0.08). When specifying concussions as an index injury, 119 (40%; 95% CI: 0.34–0.46) subsequent injuries other than a concussion were reported with 27 (9%; 95% CI: 0.06–0.13) recurrent concussions. Injury definition and type of index injury plays a significant role when considering subsequent and recurrent injury incidence in male rugby players. Further investigation regarding incidence of secondary injury after specific types of index injury is warranted.