Shoulder injuries in rugby union: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: 11.02 injuries per 1,000 player-hours (match play); training incidence 0.20 per 1,000 player-hours. Subgroup rates: male elite 13.74/1,000 h; high school/university 12.28/1,000 h

• Primary Outcome: Pooled match incidence of shoulder injuries in rugby union

• Nnt Or Sensitivity: 95% prediction interval: 2.11–57.61 injuries/1,000 player-hours (I² = 97%), indicating very wide variability across study populations. Tackling identified as predominant injury mechanism, most often affecting the tackler. Bankart, Latarjet, and Bristow procedures all associated with favourable reported outcomes; no comparative effectiveness data available between techniques.

• Confidence Interval: 95% CI 7.23–16.82 injuries/1,000 player-hours (pooled match incidence)

Clinical Application

Epidemiological findings are immediately applicable to injury surveillance, pre-season screening, and prevention programme design. Surgical findings (Bankart, Latarjet, Bristow) are consistent with current clinical practice but cannot guide technique selection due to the absence of comparative data. Implementation of standardised injury surveillance (e.g., Rugby Union Injury Consensus Group definitions) would improve future evidence quality. Rugby union is a major sport in Australia with significant participation at elite (Super Rugby, Wallabies), community, and school levels. World Rugby and Rugby Australia injury surveillance programmes align with the surveillance methodology critiqued in this review. The Latarjet procedure is widely performed in Australian orthopaedic practice for anterior shoulder instability in contact athletes and is supported by existing Australian surgical literature. RACGP and Sports Medicine Australia guidelines on return-to-sport following shoulder stabilisation are relevant to the management pathway. No specific PBS implications arise from this review, though arthroscopic Bankart repair and open Latarjet procedures are both MBS-listed. The finding of markedly higher match versus training incidence supports existing Rugby Australia player welfare initiatives targeting tackle technique modification. The identified gap in female player data is particularly relevant given the rapid growth of women's rugby in Australia. Rugby union players across all playing levels and ages, particularly male elite and high school/university players who demonstrate the highest injury incidence. Clinicians managing shoulder injuries in rugby players including sports physicians, orthopaedic surgeons, physiotherapists, and team medical staff.

Abstract

Shoulder injuries are common in Rugby Union, resulting in prolonged absence and considerable burden. Reported incidence, severity, and mechanisms vary widely, reflecting the multiple high-impact actions in the sport. Various management approaches exist to treat a wide range of pathologies. This systematic review and meta-analysis aimed to synthesise evidence on the epidemiology, mechanisms, and treatment of shoulder injuries in rugby. PUBMED, SCOPUS, and WEB OF SCIENCE were searched from database inception until 1st June 2025. From 1,099 abstracts screened, 37 studies were included. The pooled match incidence was 11.02 injuries/1,000 player-hours (95% CI 7.23-16.82), though heterogeneity was very high (I² = 97%) and the 95% prediction interval was wide (2.11-57.61 injuries/1,000 player-hours), indicating the pooled rate should be read as an average across diverse populations rather than a single representative value. Higher rates were seen in male elite (13.74/1,000 h) and high school/university players (12.28/1,000 h). Training incidence was considerably lower (0.20/1,000 h). Substantial between-study heterogeneity was observed across all incidence analyses, reflecting genuine variation across playing levels, sex, and surveillance methods. Tackling was the predominant injury mechanism, most often affecting the tackler. Bankart, Latarjet, and Bristow procedures all produced favourable reported outcomes for surgical management of anterior shoulder instability. These were indirect comparisons drawn from observational cohorts, however, and comparative effectiveness between techniques cannot be determined from the available evidence. Shoulder injuries in rugby occur far more often in matches than in training, result in prolonged time loss, and are most sustained in tackling. Surgical stabilisation is associated with favourable reported outcomes, though the comparative findings should be regarded as hypothesis-generating, and high-quality comparative studies are warranted. Greater attention to prevention, improved reporting of mechanisms, and focused research on female players should be prioritised.

References

1. 1.Doyle, J., Bellamy, M., Fowler, K., Keiller, H., Gunasekera, R., & Funk, L. (2026). Shoulder injuries in rugby union: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1136/bmjsem-2025-002492