A systematic evaluation of musculoskeletal injuries in mixed martial arts athletes: a meta-analysis

Mixed martial arts (MMA) is a popular combat sport including wrestling, boxing, and martial arts, which involves danger and violence. It is reported to have one of the greatest injury rates among different sports, limits participation, and often consists of considerable medical costs. The available literature on MMA injuries is sparse and requires a comprehensive review of injuries in this popular sport. This systematic review and meta-analysis was conducted with the aim of critically evaluating the epidemiological literature on injury patterns, mechanisms, and associated risk factors in mixed martial arts athletes.

According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures, primary English-language literature investigating MMA injuries was scanned in six databases from the time these databases were established to July 14^th, 2025. Reports that provided information on injury rates and attributes were reviewed and analyzed. The PICOS (population, intervention [participation in MMA], comparison [comparison within MMA], outcome [prevalence of specific injuries - concussions, fractures, etc.], and study design) model was used to clarify the research questions. The quality and level of reports were assessed employing the JBI method. Random effects meta-analysis on the prevalence of concussion was done using STATA software.

A total of 2520 reports were eligible for inclusion in the current review. Descriptive analysis disclosed that the prevalence of injuries ranged from 0.2 to 92.7 injuries in MMA athletes. MMA athletes suffered more upper limb injuries. Head injuries in 17 out of 55 reports (30.90%), shoulder injuries in 13 out of 55 reports (23.63%), hand injuries in 11 out of 55 reports (20.0%), elbow injuries in 10 out of 55 reports (18.18%), ankle in 10 out of 55 reports (18.18%), knee injuries in eight out of 55 reports (14.54 percent), and facial injuries in six out of 55 reports (10.90 percent) were the most frequent injuries in MMA athletes. Concussions, sprains, fractures, dislocations, tears, contusions, and strains in different body parts were also reported. There is evidence that injury rates are higher among professional MMA fighters. Striking, being struck, grappling, overuse, and takedowns were mechanisms of injuries in MMA athletes. Higher competitive level was a major risk factor for MMA athletes. Moreover, older age, weight, having a previous injury, the number of rounds, and non-submission outcome were associated risk factors. The pooled prevalence of concussion injuries in MMA athletes were 20.68%; 95% CI 17.66, 23.69. The subgroup analysis showed that the polled prevalence of concussion injuries in MMA athletes with age 31-40 years old (20.37%; 95% CI 14.82, 25.91) was higher than in athletes with age 20-30 years old (19.50%; 95% CI 3.72, 35.29).

The injury rate in MMA seems to be higher than most, if not all, other popular and common combat sports. MMA fighters, who are older, train at highly competitive levels and are exposed to competitive environments, are at accelerated risk of injury. Further epidemiological research is necessary to advance the accuracy of injury occurrence estimates, identify injury severity, and determine additional risk factors for injury in MMA athletes.