INTRODUCTION: Gymnastics has been reported to have one of the highest injury rates in sports, limiting participation and often involving significant medical costs. The current systematic review and meta-analysis research aimed to conduct a critical appraisal of the epidemiological literature on injury patterns and associated risk factors in competitive aerobic and artistic gymnasts. EVIDENCE ACQUISITION: Seven databases were searched for papers that examined injuries in competitive aerobic and artistic gymnasts. Data on injury prevalence and associated risk factors were extracted, along with data on injury type and location. The quality and level of evidence were investigated using the JBI method. Random effects meta-analysis on wrist prevalence rates was performed employing STATA software. EVIDENCE SYNTHESIS: The search found 10822 papers, of which 40 (6 studies in aerobic gymnasts, 35 studies in artistic gymnasts, and 1 study in both disciplines) were eligible for this review. Descriptive analysis revealed that the prevalence of injuries ranged from 1.0 to 69.2 injuries in aerobic gymnasts and 0.5 to 82.0 injuries in artistic gymnasts. Ankle injuries in 18 out of 40 studies (45.0%), knee injuries in 17 out of 40 studies (42.5%), wrist injuries in 15 out of 40 studies (37.5%), back injuries in 14 out of 40 studies (35.0%), shoulder injuries in 11 out of 40 studies (27.5%), and head/neck in 6 out of 40 studies (15.0%) were the greatest prevalence in all injuries. Sprains, fractures, dislocations, tears, contusions, strains, and concussions in different body parts were also found. Male gymnasts suffered more upper limb injuries, while female athletes suffered mostly lower limb injuries. The floor was associated with the highest number of injuries for both male and female athletes. Higher competitive level was a risk factor for gymnastics injury. Furthermore, age, body mass, menarcheal status, floor exercises, having an injury during the previous season, duration of training, and psychological factors were associated risk factors. The pooled prevalence of wrist injuries in gymnasts were 13.152%; 95% CI 10.65, 15.64. The subgroup analysis demonstrated that the polled prevalence of wrist injuries in gymnasts with age >20 years old (17.86%; 95% CI 9.70, 26.01) was higher than in gymnasts with age 10-14 years old (9.99%; 95% CI 5.72, 14.26). Moreover, the polled prevalence of wrist injuries in gymnasts with BMI 20-25 kg/m2 (21.80%; 95% CI 13.66, 29.95) was higher than in gymnasts with BMI<20 kg/m2 (10.18%; 95% CI 7.03, 13.34). Additionally, the polled prevalence of wrist injuries in gymnasts with training duration 20-30 hours per week (18.85%; 95% CI 13.22, 24.48) was higher than in gymnasts with training duration <20 hours per week (13.41%; 95% CI 9.35, 17.48). CONCLUSIONS: The results regarding the prevalence of injuries among aerobic and artistic gymnasts at all levels of competition are significant. Gymnasts who exercise at highly competitive levels and are exposed to competitive environments are at increased risk for injury. Future research should be focused on implementation of consistent reporting methods.
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