Background Injury risk in youth rugby is perceived as high when compared with other youth sports, and has become a notable public health topic.

Objective To investigate the incidence and nature of match-related injuries sustained in youth rugby union.

Design Two-season prospective cohort study.

Setting Independent schools within England during 2013/14 and 2015/16 playing seasons.

Participants Eligible schools had onsite medical personnel for injury treatment and data capture. All male players within the under-15 to under-18 age groups of included schools were eligible to participate. In total, 3,179 rugby players (aged 14–18 years) from 40 schools participated.

Main Outcome Measures Time-loss (>24 hours) match injury incidence (per 1000 match hours) and burden (days lost per 1000 match hours), classifications made on injury location, severity, and inciting event.

Results 598 time-loss injuries were reported from 21,865 match exposure-hours, giving an overall match injury incidence of 27 injuries/1000 match-hours (90% CI 26 to 29) and burden of 731 days lost/1000 match-hours (90% CI 721 to 740). The head was the most frequently injured location (31% of injuries), followed by the shoulder (14%), wrist/hand (12%), and knee (8%). Moderate time-loss injuries (8–28 days) were the most commonly reported (38%), followed by minor injuries (2–7 days, 33%), whilst over a quarter of injuries were severe (>28 days, 27%). Most injuries were associated with contact events (88%), particularly the tackle (58%) and ruck (14%), with 8% associated with running. Concussion incidence was 6/1000 match-hours (90% CI 5 to 7).

Conclusions Match injury incidence was similar to figures reported in recent studies, whilst injury burden and the proportion of severe injuries were lower than previously reported. Implications of this study's findings would include focusing further on identifying risk factors and preventive strategies for tackle-related injuries as well as for head injuries, particularly concussion, in youth rugby.