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Background: Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player’s career. Hypothesis: The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification). Results: The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis. Conclusion: The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.

The study aimed to illustrate how contact (from match‐event data) and head acceleration event (HAE) (from instrumented mouthguard [iMG]) data can be combined to inform match limits within rugby. Match‐event data from one rugby union and rugby league season, including all competitive matches involving players from the English Premiership and Super League, were used. Playing exposure was summarised as full game equivalents (FGE; total minutes played/80). Expected contact and HAE exposures at arbitrary thresholds were estimated using match‐event and iMG data. Generalised linear models were used to identify differences in contact and HAE exposure per FGE. For 30 FGEs, forwards had greater contact than backs in rugby union (n = 1272 vs. 618) and league (n = 1569 vs. 706). As HAE magnitude increased, the differences between positional groups decreased (e.g., rugby union; n = 34 and 22 HAE >40 g for forwards and backs playing 30 FGEs). Currently, only a relatively small proportion of rugby union (2.5%) and league (7.3%) players exceeded 25 FGEs. Estimating contact and HAEs per FGE allows policymakers to prospectively plan and model estimated overall and position‐specific loads over a season and longer term. Reducing FGE limits by a small amount would currently only affect contact and HAE exposure for a small proportion of players who complete the most minutes. This may be beneficial for this cohort but is not an effective HAE and contact exposure reduction strategy at a population level, which requires individual player management. Given the positional differences, FGE limits should exist to manage appropriate HAE and contact exposure. Highlights Estimating contact events and head acceleration events (HAEs) per full game equivalents (FGE, i.e., 80 minutes) allows policymakers to prospectively plan and model estimated overall and position‐specific loads over a season and longer term. Through retrospectively analysing FGE exposure, the findings demonstrate that only a small proportion of rugby players would be affected by a feasible reduction in FGE limits, but the difference in contact and HAE exposure for these players could be significant over the duration of a playing career. Per FGE in both rugby codes, forwards have a greater expected contact and head acceleration event exposure than backs, and thus any implemented FGE limits should at least be position group‐specific and ideally incorporate individual player management.

This study aimed to quantify the frequency of individual and team contact events during rugby union match play in top domestic and international men’s and women’s competitions. Analyst‐coded player individual and team contact event types (tackles, carries, attacking rucks and defensive rucks, lineouts, scrums and mauls) from the 2022/2023 rugby union season were analysed from top domestic and international competitions across the world using generalised linear mixed models. For both women’s and men’s rugby, competitions generally had similar numbers of contact events per playing position. Where differences were observed, most ranged between 0.5 and six per contact event per full game equivalent (FGE). Similar trends were observed when comparing women’s to men’s rugby. However, within‐game accumulation of these different contact events for certain positional groups may have a significant impact (e.g., a front five player called up from a Farah Palmer Cup team to play in WXV1 could be involved in as much as 6 more attacking rucks, 3 more tackles and 5 more mauls per game on average). Furthermore, the small differences between competitions per FGE may accrue across matches and thus result in far greater exposures across a season (e.g., a front five player in Premiership Rugby may make 48 more tackles over 20 matches than in Top 14 on average). Although a high proportion of contact events per FGE were similar between competitions and sexes per playing position, differences that were observed may have important implications for players transitioning between competitions and the long‐term exposure of players to higher‐risk contact events.

Abstract BACKGROUND Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI. OBJECTIVE To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted. RESULTS Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size > 10 mm (52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (β = –0.58, 95% CI –0.111, –0.005, P = .033). CONCLUSION RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.

This scoping review explored the physical qualities, and match demands of athletes participating at elite and sub-elite levels in four team-based collision sports played in Australia: Australian football, rugby union, rugby sevens, and rugby league. Fifty-nine studies were analysed to examine anthropometric traits, physical qualities, and match demands of female athletes across these sports. Comparisons were made between elite and sub-elite playing levels. A risk of bias and methodological assessment was also conducted. Findings suggest that elite athletes (as defined by the FTEM framework) in all sports, except rugby sevens, displayed greater height and body mass than sub-elite counterparts. Elite athletes in Australian football, rugby sevens, and rugby league demonstrated superior aerobic capacity, as measured by the Yo-Yo Intermittent Recovery Level 1 (IR1) test. Elite rugby union athletes were faster over 10-metre acceleration efforts and had higher average one-repetition maximum (1RM) bench press scores. The risk of bias assessment showed that 60% of studies had 'unclear' or 'high risk' of confounding due to uncontrolled or unreported contextual factors. All studies had 'low risk' of bias in assessor blinding and selective outcome reporting. These findings highlight the importance of specific anthropometric traits and physical qualities, such as greater body mass, lean mass, and aerobic capacity, as well as performance outcomes like relative running intensity and peak velocity, in distinguishing playing levels. These attributes can inform talent identification, enhance performance, and guide training interventions for sub-elite and elite female athletes.

Women's rugby is experiencing unprecedented growth and professionalisation, yet the research underpinning player welfare and performance remains significantly underdeveloped. This special issue of the European Journal of Sport Science addresses the critical need for evidence‐based practices tailored to female rugby players. Current literature is predominantly male‐focused, despite known sex differences impacting training, injury mechanisms and health outcomes. In particular, the underrepresentation of female‐specific studies presents risks to player safety and performance optimisation. This issue presents cutting‐edge research, from world‐leading interdisciplinary experts and applied practitioners, on three main themes: female‐specific injury and illness surveillance and education, tackle safety and performance, and intersectional research agendas. Contributions include insights into female‐specific health domains, such as breast and pelvic floor health, emphasising the need for tailored care pathways and interventions. Additionally, the importance of gender‐responsive coaching and tackle skill acquisition is highlighted, advocating for progressive, context‐specific training frameworks. Moreover, an intersectional approach to research is proposed, to address the broader social and material contexts affecting marginalised women and girls in rugby. These findings aim to drive interdisciplinary, inclusive research, ensuring that the professionalisation of women's rugby is matched by advancements in scientific understanding and applied practice. This special issue not only celebrates the progress made, but also calls for ongoing efforts to bridge the knowledge gap, ensuring holistic support for female rugby players from participation, through to retirement and beyond.

Background The consequences of exposure to head acceleration events (HAEs) in collision sports, including Australian Rules football, are a growing concern. Instrumented mouthguards (iMGs) now enable accurate quantification of HAEs in sport; however, little is known about HAE incidence and mechanisms in Australian Rules football. We aimed to measure HAEs in elite Australian Rules football players, and evaluate the influence of playing position and match event on the incidence and magnitude of HAEs in men and women. iMG data were collected from Australian Football League (AFL) and AFL Women’s (AFLW) players in 2023 utilising the HIT-IQ Nexus Gen III iMG, targeting 500 player-matches per sex. Match footage was synchronised with iMG data for video verification and match play coding. Results Three hundred and eleven players contributed iMG data in the analyses, including 126 men (median matches per player: 3 (interquartile range [IQR: 2–6]) and 185 women (median: 3 [IQR: 1–4]). Men had a higher mean incidence of HAEs ≥ 8 g per match than women (5.7 [95% confidence interval CI: 5.0–6.4] vs. 3.0 [95% CI: 2.8–3.3]), however the incidence was comparable when adjusted for time (3.6/hour [95% CI: 3.2–4.1] vs. 3.1/hour [95% CI: 2.9–3.4]). Men recorded higher maximum single-impact peak linear acceleration (PLA; median 31 g vs. women: median 22 g; p  < 0.001) and peak rotational acceleration (PRA; median 3.0 krad/s² vs. women: 2.4 krad/s²; p  < 0.001) per match. Conversely, women experienced greater PRA per impact (median 1.4 krad/s² vs. men: 1.2 krad/s²; p  < 0.001), while PLA was similar (men: median 14 g, women: median 13 g; p  = 0.330). The leading match events resulting in HAEs were marking contests (1.0/hour) in men and contested ball situations (0.8/hour) in women. HAE incidence and magnitude were generally comparable across playing positions, except for men’s rucks, who experienced significantly higher incidence of HAEs (6.5/hour) than forwards (3.6/hour), midfielders (3.2/hour), and defenders (2.7/hour). Conclusions This study highlights differences in HAE incidence, magnitude, and mechanisms by sex, playing position, and match events in elite-level Australian Rules football. These findings provide insight into impact exposure patterns and may inform targeted skill development and policy adjustments to enhance player safety. Key Points In elite-level Australian Rules football, men sustained more instrumented mouthguard-measured head acceleration events (HAEs) per match compared to women; however, incidence was similar after adjusting for time played. Men experienced higher maximum single-impact peak linear and rotational accelerations values per match, while women experienced greater peak rotational acceleration per HAE. Men’s rucks had a significantly higher incidence of HAEs than defenders, midfielders, and forwards, primarily due to more frequent low-magnitude impacts from ruck and marking contests.

This study investigated the effects of skill-based conditioning games and traditional conditioning for improving speed, agility, muscular power, and maximal aerobic power in rugby league players. Sixty-nine subelite rugby league players performed either a skill-based conditioning games program (N = 32) or a traditional conditioning (i.e., running activities with no skill component) program (N = 37). Each player participated in a 9-week in-season training program, performed over 2 competitive seasons. Players performed 2 organized field-training sessions each week. Players underwent measurements of speed (10-m, 20-m, and 40-m sprint), muscular power (vertical jump), agility (L run), and maximal aerobic power (multi-stage fitness test) before and after the training period. Skill-based conditioning games induced a significant improvement (p < 0.05) in 10-m, 20-m, and 40-m speed, muscular power, and maximal aerobic power, whereas traditional conditioning activities improved 10-m speed and maximal aerobic power only. No significant differences (p > 0.05) were detected between the traditional conditioning and skill-based conditioning games groups for changes in 10-m speed, agility, and maximal aerobic power. Both groups won 6 of 8 matches played within the training period, resulting in a win-loss ratio of 75%. However, on average, the skill-based conditioning games group scored more points in attack (p < 0.05) and had a greater (p < 0.05) points differential than the traditional conditioning group. The results of this study demonstrate that skill-based conditioning games offer an effective method of in-season conditioning for rugby league players. In addition, given that skills learned from skill-based conditioning games are more likely to be applied in the competitive environment, their use may provide a practical alternative to traditional conditioning for improving the physiological capacities and playing performance of rugby league players.

Well-developed physical qualities may protect against contact injuries. However, the potential contribution of physical qualities as risk or protective factors to contact injury risk is yet to be determined for rugby league. This study applied a frailty survival model that accounts for recurrent injury to identify risk factors for all physiotherapist-reported contact injury in professional rugby league players. Prospective cohort study. Sixty-six professional rugby league players participated in this three successive year prospective study. At the start of each season, all players underwent measurements of standard anthropometry (height, body mass, and sum of seven skinfolds), speed (10m and 40m sprint), muscular strength (1 repetition maximum [RM] bench press, 1RM squat, 1RM weighted chin-ups), power (vertical jump, bench throw, 1RM power clean, jump squat), and endurance (maximum repetition bench press with 60kg resistance), repeated-sprint ability (12×20m sprints performed on a 20s cycle), prolonged high-intensity intermittent running ability (8×12s maximal effort shuttles performed on a 48s cycle), and maximal aerobic power (multi-stage fitness test). Data was used to demonstrate the application of the frailty model extension of the Cox proportional regression model for recurrent events to identify factors associated with a high hazard ratio (HR) of injury. Heavier (body mass, HR=2.6, 95% CI=1.2–5.7), and faster (40m sprint, HR=2.1, 95% CI=1.0–4.2) players, and those with poorly developed prolonged high-intensity intermittent running ability (HR=2.9, 95% CI=1.7–5.0) and upper-body strength (chin-up, HR=2.2, 95% CI=1.3–3.7) had a higher incidence of contact injuries. This study demonstrates application of a novel statistical approach for the analysis of injury data that is recurrent in nature. This approach identified that the greater impact forces generated from heavier players with faster speed may result in an increase in recurrent contact injury rates. However, the development of prolonged high-intensity intermittent running ability and upper-body strength and power may assist to reduce the risk of contact injury in professional rugby league players.

This study investigated the physiological and anthropometric characteristics of elite women rugby league players and developed physical performance standards for these athletes. Thirty-two elite women rugby league players underwent measurements of standard anthropometry (body mass, height, sum of 7 skinfolds), muscular power (vertical jump), speed (10-, 20-, and 40- m sprint), agility (505 test), glycolytic capacity (glycolytic agility test), and estimated maximal aerobic power (multistage fitness test). The skinfold thickness, speed, agility, vertical jump height, glycolytic capacity, and estimated maximal aerobic power results were 6.0-38.1% poorer than previously reported for elite women team sport athletes (e.g., rugby union, soccer, and hockey). Although no significant differences (p > 0.05) were detected between selected and nonselected players for any of the physiological or anthropometric characteristics, significant differences (p < 0.05) were detected between forwards and backs for body mass, skinfold thickness, 10-, 20-, and 40-m speed, and estimated maximal aerobic power. When data were analyzed according to positional similarities, it was found that the hit-up forwards positional group were heavier, had greater skinfold thickness, and had lower 10-, 20-, and 40-m speed, muscular power, glycolytic capacity, and estimated maximal aerobic power than the adjustables and outside backs positional groups. The results of this study show that elite women rugby league players have slower speed and agility, lower muscular power, glycolytic capacity, and estimated maximal aerobic power, and greater body mass and skinfold thickness than previously reported for other elite women team sport athletes. These findings show the need to develop all physiological parameters to allow elite women rugby league players to more effectively tolerate the physiological demands of competition, reduce fatigue-related errors in skill execution, and decrease the risk of injury.