Twenty year analysis of professional men’s rugby union knee injuries from the English premiership shows high rates and burden

Objectives To determine the rates, severity and burden of knee injuries in professional male rugby union from the English Premiership. Methods Injury and exposure data were captured over 20 seasons using a prospective cohort design. Knee injury incidence, days’ absence and burden were recorded for each injury type and by pitch surface type for match and training. Results The rate of knee injury in matches was 9.8/1000 hours (95% CIs 9.3–10.3). Mean days lost were 50 (95% CI 46 to 53) in matches and 51 (95% CI 44 to 57) in training. In matches, medial collateral ligament injuries were the most common, while anterior cruciate ligament (ACL) injuries had the highest mean severity and burden. There was no significant change in the count of knee injuries over time; however, average severity increased significantly (annual change: 2.18 days (95% CI 1.60 to 2.77); p<0.001). The incidence of match knee injury was 44% higher on artificial pitches than grass pitches (incidence rate ratio: 1.44 (95% CI 1.21 to 1.69); p<0.01), with no significant difference in severity between surfaces. In matches, the tackle was the event most commonly associated with knee injuries for all diagnoses, except ACL injuries (running). In training, running was a more common injury event than the tackle. Conclusion Knee injuries in matches are common and severe in English professional men’s rugby union. Despite an increased focus on player conditioning and injury prevention throughout the study period, rates of knee injury remained stable, and resulting days’ absence increased. New strategies for the prevention of knee injuries should be considered a priority. All data relevant to the study are included in the article or uploaded as supplementary information. All publicly available data are included in the article or uploaded as online supplemental information. Furthermore, detail of all injury types are published annually as reports for the Professional Rugby Injury Surveillance Project.