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Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis
  1. Liam A Toohey1,2,3,
  2. Michael K Drew2,3,
  3. Jill L Cook1,3,
  4. Caroline F Finch1,3,
  5. Jamie E Gaida4,5
  1. 1School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department, La Trobe University, Bundoora, Victoria, Australia
  2. 2Department of Physical Therapies, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
  3. 3Australian Centre for Research into Injury in Sport and Its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
  4. 4University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australian Capital Territory, Australia
  5. 5Department of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia
  1. Correspondence to Liam A Toohey, School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department La Trobe University Bundoora, Victoria 3086, Australia ; liam.toohey{at}


Background Previous injury is a strong risk factor for recurrent lower limb injury in athletic populations, yet the association between previous injury and a subsequent injury different in nature or location is rarely considered.

Objective To systematically review data on the risk of sustaining a subsequent lower limb injury different in nature or location following a previous injury.

Methods Eight medical databases were searched. Studies were eligible if they reported lower limb injury occurrence following any injury of a different anatomical site and/or of a different nature, assessed injury risk, contained athletic human participants and were written in English. Two reviewers independently applied the eligibility criteria and performed the risk of bias assessment. Meta-analysis was conducted using a random effects model.

Results Twelve studies satisfied the eligibility criteria. Previous history of an ACL injury was associated with an increased risk of subsequent hamstring injury (three studies, RR=2.25, 95% CI 1.34 to 3.76), but a history of chronic groin injury was not associated with subsequent hamstring injury (three studies, RR=1.14, 95% CI 0.29 to 4.51). Previous lower limb muscular injury was associated with an increased risk of sustaining a lower limb muscular injury at a different site. A history of concussion and a variety of joint injuries were associated with an increased subsequent lower limb injury risk.

Conclusions The fact that previous injury of any type may increase the risk for a range of lower limb subsequent injuries must be considered in the development of future tertiary prevention programmes.

Systematic review registration number CRD42016039904 (PROSPERO).

  • subsequent injury
  • sports injury
  • athletic injury
  • injury risk
  • epidemiology

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  • Contributors LAT, CFF, JLC, MKD and JEG contributed to the original concept. LAT and JEG designed the search strategy that LAT executed. LAT and MKD undertook the process of inclusion/exclusion and independently assessed methodological criteria. LAT extracted all data from the included studies and MKD confirmed the accuracy of this. All authors contributed to the drafting and final approval of the manuscript. This work was undertaken by LAT as a component of his PhD under the supervision of authors JLC, CFF, MKD and JEG.

  • Funding This work was supported by an Australian Government Research Training Program Scholarship awarded to author LAT for support during his PhD. JLC was supported by an NHMRC Practitioner Fellowship (ID058493). The Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.