Objective This study investigates the days of absence after concussion in the two highest professional football (soccer) leagues in Germany between 2014 and 2020.

Design Retrospective analysis of all concussions registered by clubs or physicians at the trauma insurance (VBG) as part of mandatory occupational accident reporting.

Setting Men´s German 1st and 2nd Bundesliga.

Participants 152 players with diagnosed concussion (mean age 25.1 years ± 4.0 standard deviation).

Interventions (or Assessment of Risk Factors) Inter-season and inter-league comparisons were calculated by Kruskal-Wallis (KW) and unpaired samples t-tests.

Outcome Measures Prevalence, match incidence rates and days of absence.

Main Results 126 of 172 (73.3%) reported concussions during 138.000 hours of match play result in a match incidence of 0.91 per 1.000 match hours. Concussion prevalence was 3.0% (range 2.5–4.0) per player per season (median 26.5 concussions per season, range 24–32). Mean time loss in days per concussion was significantly longer in the 1st compared to the 2nd Bundesliga (mean ± standard deviation: 7.29 ± 5.99 vs. 5.00 ± 4.46, p < 0.05). Absence time in the 1st Bundesliga was significantly longer in season 2019/20 (9.5 ± 4.8, median=8) compared to 2014/15 (3.89 ± 3.95, median=3) and 2015/16 (3.92 ± 4.42, median=3) (p<0.05), but there were no significant changes over time in the 2nd Bundesliga (2014/15: 4.29 ± 3.12, median=4 vs. 2019/20: 5.54 ± 6.27, median=2).

Conclusions Absence time after concussion differs significantly between professional football (soccer) leagues in Germany. Concussion policies may have influenced adherence to concussion protocols in the 1st Bundesliga.