Incidence Rates and Pathology Types of Boxing-Specific Injuries: A Systematic Review and Meta-analysis of Epidemiology Studies in the 21st Century

BACKGROUND: To the best of our knowledge, an evidence-based investigation into 21st-century boxing-specific injury rates and types has yet to be performed. PURPOSE: To provide an overview and quantitative synthesis of the incidence rates (IRs) and pathological categorizations of boxing-specific injuries in the 21st century. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched literature published from January 2000 to November 2021 in PubMed and the Cochrane Library systematically for qualifying epidemiology studies of organized boxing activities across the world. Two independent reviewers completed the literature review, data extraction, and quality assessment. The IRs of injuries per 1000 boxers (IR(N)), per 1000 competition exposures (IR(E)), and per 1000 minutes of competition (IR(C)) or training (IR(T)) were subsequently calculated. Single-arm meta-analyses were performed for the subgroups of different types of boxing. Sample size weighted means were calculated using a random-effects model in all studies with 95% CIs. RESULTS: Out of an initial 9584 articles, 14 studies were included, with most (11/14) having a moderate level of quality. The pooled IR(N) in overall injuries was 223.9 (95% CI, 157.5-290.4), the IR(E) was 233.3 (95% CI, 161.3-305.2), and the IR(C) was 13.0 (95% CI, 8.9-17.1). In professional boxing, the IR(N) (399.8), IR(E) (379.8), and IR(C) (23.9) were all significantly higher than in the amateur and female groups. The IR(E) (76.6 vs 250.6; P < .000) and IR(C) (9.2 vs 15.4; P < .000) in amateur boxing were significantly lower in studies between 2010 and 2019 than in earlier studies. For pathology categorization, the pooled frequencies were 12.3% (95% CI, 8.7%-15.9%) for concussion, 21.4% (95% CI, 14.1%-28.6%) for skin laceration, 30.2% (95% CI, 22.1%-38.2%) for soft tissue contusion, 15.3% (95% CI, 7.7%-22.9%) for sprain and muscle/ligament injury, and 11.4% (95% CI, 2.7%-20.1%) for fracture. CONCLUSION: IRs of injury remain high in professional boxing, although they have decreased in the past 10 years in amateur boxing. Soft tissue contusion was the most common injury type. Better exposure measurements and epidemiologic indicators should be applied in future studies. REGISTRATION: CRD42021289993 (PROSPERO).