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Clin J Sport Med. 2019 Aug 12. doi: 10.1097/JSM.0000000000000752. [Epub ahead of print]

Time of Season and Game Segment Is Not Related to Likelihood of Lower-Limb Injuries: A Meta-Analysis.

Author information

Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.
School of Allied Health, La Trobe University, Bundoora, Victoria, Australia.



Fatigue due to game play is often cited as a factor in musculoskeletal injuries; however, it is unclear whether or not this view is supported by published research findings. Given the importance researchers and practitioners place on the potential effects of game play with respect to injury, it is important to understand what inferences can be drawn from the collective research in this realm. This meta-analysis will consider the time of season and segment of the game, as it relates anterior cruciate ligament (ACL), groin, and hamstring injury occurrence.


Database searches were run in PubMed, MEDLINE, SportDiscus, CINAHL, and Ausport, in addition to the inclusion of articles identified manually.


Search terms were chosen to identify articles related to each of the 3 injuries of interest. There were no date limitations placed on the articles, as such, all published articles listed in the databases up to November 2017 were eligible for selection if they met the search criteria.


Initial searches yielded 1349 articles, and this was eventually reduced to 15 articles deemed suitable for inclusion in the meta-analysis, which provided 21 data sets.


Comparing the first half with the second half of the season, there were no differences in ACL, groin, or hamstring injury occurrences [ACL: odds ratio (OR), 1.27; confidence interval (CI), 0.43-3.78, groin: OR, 1.79; CI, 0.63-5.06, and hamstring: OR, 1.16; CI, 0.88-1.53]. Similarly, there were no differences in injury occurrence between the first and second halves of the game for the ACL or hamstring injuries (ACL: OR, 0.43; CI, 0.47-7.92, hamstring: OR, 0.85; CI, 0.58-1.24).


Findings from this meta-analysis determined that time in season or time in game does not influence risk of the ACL, groin, or hamstring injury. Commonly, many studies did not provide sufficient detail to be included in the meta-analysis. Consequently, it is recommended that future studies report data related to the timing of the injury within the season or game.

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