Background The number of elite junior tennis players is growing. However, very little is known about the risk factors for injuries in this specific population.

Objective To identify risk factors for musculoskeletal injuries in elite youth tennis players.

Design A prospective cohort study during the 2012–2013 Dutch tennis season.

Setting Elite youth players.

Participants Players were recruited from the Dutch national high-performance program during the pre-season intake. Seventy-three players agreed to participate (age range 11–14 years, 29 girls and 44 boys). All 73 players completed the entire follow-up period.

Assessment of Risk Factors At baseline all players underwent a basic screening. Potential risk factors recorded included: (1) anthropometric data, (2) joint range of motion(ankle, hip, and shoulder), (3) pubertal stage, (4) current physical complaints.

Main Outcome Measurements During the season, players reported physical complains on a weekly basis through the OSTRC injury questionnaire. The outcome of interest were the musculoskeletal injuries, subdivided into acute and overuse injuries.

Results During the season, 113 musculoskeletal injuries were reported (78% overuse injuries). For acute injuries, no significant risk factors could be identified. Only pre-season complaints showed a borderline association with all acute injuries (HR 0.36 [95% CI 0.12–1.06], yes=1). When only considering lower extremities, a significant association between preseason complaints and injury at the lower extremity could be reported (HR 0.29 [95% CI 0.10–0.88], yes=1). Overuse injuries were significantly associated with total hours of sports participation (OR 7.15 [95% CI 1.32–38.98]) and wearing supportive insoles (OR 0.13 [95% CI 0.02–0.79], yes=1).

Conclusions Preseason complaints, total hours of sports participation and the use of supportive soles were the factors associated of injuries in elite youth tennis players. Gender, pubertal stage and range of motion were not found to be risk factors for tennis injuries.