Subsequent Injury Risk Is Elevated Above Baseline After Return to Play: A 5-Year Prospective Study in Elite Australian Football

Background: The risk of sustaining a subsequent injury is elevated in the weeks after return to play (RTP) from an index injury. However, little is known about the magnitude, duration, and nature by which subsequent injury risk is increased. Purpose: To quantify and describe the risk of injury in a 12-week period after RTP from an index injury in Australian football players. Study Design: Cohort study; Level of evidence, 2. Methods: Injury data were collected from 79 players over 5 years at 1 Australian Football League club. Injuries were classified with the Orchard Sports Injury Classification System and by side of the body. Furthermore, injury severity was classified as time loss (resulting in ≥1 matches being missed) or non–time loss (no matches missed). Subsequent injury was categorized with the SIC-2.0 model and applied to the data set via an automated script. The probability of a time loss subsequent injury was calculated for in-season index injuries for each week of a 12-week period after RTP via a mixed effect logistic regression model. Results: Subsequent injury risk was found to be highest in the week of RTP for both time loss injuries (9.4%) and non–time loss injuries (6.9%). Risk decreased with each week survived after RTP; however, it did not return to baseline risk of participation (3.6%). Conclusion: These findings demonstrate that athletes returning to play are at an increased risk of injury for a number of weeks, thus indicating the requirement for tertiary prevention strategies to ensure that they survive this period.