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. 2025 Sep 29.
doi: 10.1007/s40279-025-02326-y. Online ahead of print.

Epidemiology of Injury in Elite and Amateur Soccer Referees: A Systematic Review and Meta-analysis

Mohammad Alimoradi  1 , Mohammad Alghosi  2   3 , Mojtaba Iranmanesh  1 , Mohammed Moinuddin  4 , Nicola Relph  5
Affiliations

Epidemiology of Injury in Elite and Amateur Soccer Referees: A Systematic Review and Meta-analysis

Mohammad Alimoradi et al. Sports Med. .

Abstract

Background: The epidemiology of injury in soccer has traditionally focused on soccer players, rather than match officials. Although injury data on referees exist, no comprehensive review has summarized injury profiles in this population.

Objective: To conduct a systematic review and meta-analysis of injury epidemiology in elite and amateur soccer referees, focusing on injury rates, types, locations, severity, and causes.

Methods: PubMed (Medline), Web of Science, Scopus, CINAHL, and SPORTDiscus, covering their entire history up to 19 April 2025 were searched. This review included prospective and retrospective studies reporting injury incidence or prevalence among football match officials, with a study period of at least one season. Studies needed to specify injury definitions and include data on injury location, type, mechanism, or severity. Both male and female officials were eligible. Systematic reviews, commentaries, and letters were excluded. Study quality and risk of bias were evaluated using the STROBE-SIIS, in addition to the Newcastle-Ottawa Scale and funnel plots. Injury incidence rates were estimated using a random effects Poisson regression, accounting for heterogeneity and moderators. Heterogeneity was assessed with the I2 statistic.

Results: A total of 17 studies were included, encompassing 3621 referees. The most frequent injuries were strains and sprains in the knee and ankle. The overall injury incidence was 2.19 injuries per 1000 h of exposure (95% CI 1.30-3.69). On-field referees experienced an incidence rate of 1.46 injuries per 1000 h of exposure (95% CI 0.76-2.81), while assistant referees had a lower rate of 0.84 per 1 h of exposure (95% CI 0.36-1.97). During matches, the injury incidence was 2.24 per 1000 h of exposure (95% CI 1.38-3.64), compared with 0.67 injuries per 1000 h of exposure during training sessions (95% CI 0.36-1.24). However, despite sensitivity analysis, there were still high levels of heterogeneity across included studies.

Conclusions: Findings noted higher injury incidence during matches compared with training, and on-field referees compared with assistants. The variation in injury profiles highlights the importance of implementing targeted preventive strategies tailored to the unique demands of refereeing. However, there is still a lack of research in this population, especially in female referees.

Prospero registration number: CRD42024497970.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article. Availability of data and materials: All studies from which data were examined are cited in the references section. Ethics approval: Ethics approval was not required as the current paper is a systematic review. Authors’ contributions: The study’s conception and design were contributions from M.ALI. The initial draft of the manuscript was written by M.ALI., M.ALG., and M.I. with input and feedback provided by N.R. on earlier versions. M.ALI., N.R. M.ALG., and M.I. were involved in implementing the search strategy, applying inclusion/exclusion criteria, and administering the quality scoring system. N.R. and M.M. completed the meta-analysis. Finally, all authors reviewed and gave their approval for the final version of the manuscript. Informed consent: Informed consent for subjects within the studies that this review encompasses was obtained for all relevant studies by the researchers conducting those studies.

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