BMC Sports Sci Med Rehabil. 2025 Dec 17. doi: 10.1186/s13102-025-01485-9. Online ahead of print.
ABSTRACT
OBJECTIVE: This systematic review and meta-analysis aimed to quantify the risk of subsequent all-cause, recurrent concussion, upper extremity, and lower extremity injuries in athletes with a history of sport-related concussion.
METHODS: Following PRISMA guidelines, cohort studies published from inception through August 2025 were retrieved from PubMed, Cochrane Library, Embase, Web of Science, and EBSCO. The methodological quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Pre-specified subgroup and meta-regression analyses were conducted to investigate sources of heterogeneity, including injury timing, study design, sport type, and athlete competition level.
RESULTS: Nineteen cohort studies involving 86,879 athletes were included. Athletes with a history of concussion had significantly higher odds of sustaining a subsequent all-cause injury (OR = 1.93; 95% CI = 1.39-2.68). The risk was most pronounced for recurrent concussion (OR = 3.06; 95% CI = 1.81-5.17), and was also significantly elevated for upper extremity (OR = 1.76; 95% CI = 1.10-2.81) and lower extremity injuries (OR = 1.49; 95% CI = 1.06-2.09). Given the high heterogeneity observed in the primary outcomes (I2 > 90%), the pooled effect sizes should be interpreted with caution as average associations across varying study contexts, rather than as precise predictions applicable to all settings. Subgroup analysis revealed that injury risk was statistically significant in studies with follow-up periods beyond six months (OR = 1.94) but not for shorter durations. The association was strongest and statistically significant among college athletes (OR = 2.29; 95% CI = 1.53-3.44), while estimates for professional and high school athletes were not significant. Meta-regression identified sport type as a significant moderator of injury risk (p = 0.038).
CONCLUSION: A history of concussion significantly increases the risk of subsequent injuries, with the odds being highest for recurrent concussion. The persistence of this risk beyond six months suggests that clinical recovery does not equate to full functional recovery. These findings underscore the need for enhanced return-to-play protocols that incorporate objective functional assessments and targeted rehabilitation to mitigate the heightened vulnerability to injury in post-concussed athletes.
PMID:41402865 | DOI:10.1186/s13102-025-01485-9
