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Differences in Injury Rates by Competition Level Among Scholastic and Collegiate Female Lacrosse Athletes: A
Carrie J Froemming1, Daniel C Touhey1, Robert H Brophy1
1Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Background:
Women's lacrosse is an increasingly popular sport. Current rules allow incidental body and stick-to-stick contact, with limited required protective equipment. Injuries to the head, face, and lower extremities are common, especially at higher levels of competition. Differences in injury rates and types based on competition level remain largely unknown.
Purpose:
To systematically review the literature to better understand injury differences between scholastic and collegiate female lacrosse athletes.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
Under PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), 543 studies were identified in September 2025 in PubMed, Scopus, Google Scholar, and Cochrane Central databases that reported on injuries occurring in female scholastic (youth/high school) and collegiate lacrosse players. Inclusion criteria included studies reporting injury rates per athletic exposure (AE), injury mechanisms, body regions injured, injury diagnosis, and injury setting (practice vs game). Incidence rates for variables of interest were pooled as proportions using inverse-variance weighting and displayed in forest plots, with heterogeneity among studies assessed by the I 2 statistic.
Results:
A total of 31 studies were identified and included in our analysis. The overall injury rate was 3.83 (range, 0.11-5.19) per 1000 AEs for collegiate athletes versus 0.72 (range, 0.07-8.69) for scholastic athletes. A significantly higher proportion of injuries occurred in scholastic athletes from direct contact with the ball (15.2% [556/3644] vs 7.9% [211/2668]; P < .001) and stick (18.7% [683/3644] vs 9.4% [116/1233]; P < .001), while collegiate players sustained a greater number of direct player-to-player injuries (15.2% [4508/29,651] vs 13.5% [513/3807]; P = .005) and noncontact injuries (36.9% [10,927/29,651] vs 22.7% [968/4269]; P < .001). Injuries to the head and face (19.4% [914/4718] vs 14.8% [4429/29,991]; P < .001), including concussions (16.8% [583/3470] vs 11.4% [3317/29,101]; P < .001), as well as ankle injuries (23.7% [637/2681] vs 16.2% [4817/29,723]; P < .001), were greater in scholastic athletes, while collegiate players sustained a higher number of knee injuries (18.1% [5381/24,342] vs 14.5% [455/3143]; P < .001) and lower leg injuries (10.6% [3146/29,733] vs 5.3% [127/2388]; P < .001). Injuries occurred more frequently during game competition at both competition levels.
Conclusion:
This review showed that in female lacrosse athletes, overall injuries were greater in collegiate athletes when compared with scholastic athletes, with a significantly greater proportion of player-to-player, noncontact, knee, and lower leg injuries at the collegiate level. Injuries to the head, face, and ankle, along with injuries involving contact with the ball and stick, were more commonly reported among scholastic athletes. Further studies evaluating potential rules and equipment modifications may guide targeted injury prevention strategies to improve athlete safety at the scholastic and collegiate levels.
