Background While athletes and coaches, government policy-makers, and sports managers need evidence for decision-making, unambiguous terms and definitions for reporting and analyzing sports injuries across settings are lacking.

Objective To define unambiguous concepts for reporting sports injuries across settings.

Design Meta-analysis of sports injury-related concepts followed by development of an integrated conceptual framework and appraisal of current sports injury definition practices.

Setting Definitions used in the scientific literature on sports injury, injury concepts related to the ICD and ICF, and action-theoretical notions used describe disability.

Main outcome measures Definition of reportable episodes employed in consensus statements about injury reporting in specific sports and in epidemiological studies of athletics injuries published in PubMed before October 2009.

Results A three-context framework for cross-referencing of sports injury-related concepts was developed using the WHO notion of impairment as foundation, that is, loss or abnormality of psychological, physiological, or anatomical structure or function. In each context, the concepts are differentiated with regard to the duration of the process leading to the loss or abnormality, reflecting the possibilities for prevention and clinical interventions. This three-context framework covered all definitions of sports injury in the evaluated studies (18/18). In comparison, no single study used a definition of sports injury that covered all contexts included in the three-context framework. The sports institution context (‘time loss from sports’) dominated the definitions of reportable events (13/18 studies). Data from the athlete self-evaluation context was only included in three of the 18 studies. None of the studies used clinical screening as the primary context for defining injury.

Conclusion Present practices for definition of sports injury have important limitations. A three-context framework representing the major stakeholder perspectives (the athlete, clinical medicine, and sports institutions) have been defined and situated with regard to international definitions of injury, disease, and function.