Lower limb injuries and their association with anthropometrics : an observational study of 381 German elite youth football players

Abstract

Background Youth football players are at high risk of lower limb injuries, which can affect performance and long-term career development. However, epidemiological data on injury patterns in German elite youth football remain limited. This study aims to (1) provide an overview of lower limb injuries in German elite youth football academies and (2) investigate the association between anthropometric factors, particularly genu varum, and injury risk. Methods This cross-sectional study included 381 healthy male football players (aged 10–23 years) from two German elite youth academies between 2021 and 2023. Injury history from the most recent full league season, including pre-season and regular season matches, was recorded. Anthropometric assessments included body composition and intercondylar distance of the knee (ICD) to evaluate genu varum. Results A total of 140 lower limb injuries were documented, resulting in a cumulative injury frequency of 0.39 and an incidence of 1.2 injuries per 1,000 h. Most injuries were muscle-tendon injuries in the thigh (36.4%) and ligament injuries in the ankle (35.0%). Injury hot spots included lateral ligament tears in the ankle (30.0%) and muscle injuries within a triangle of the hamstrings (12.9%), quadriceps (10.7%), and adductors (11.4%) in the thigh. Injury frequency significantly increased from age 13 (p =.013; OR = 2.29), particularly in the thigh (p =.027; OR = 3.28). Regression analysis revealed a significant correlation between age (p =.038; coefficient of variation (COV) = -0.07) and ICD (p =.003; COV = -0.01) on the number of injuries, suggesting a potential link between genu varum and increased injury risk. Conclusion This study provides the first structured overview of lower limb injuries in two German elite youth football academies and their association with anthropometric data. The findings highlight age-related injury patterns and suggest a potential link between genu varum and injury risk, underlining the need for targeted injury prevention strategies. Establishing a systematic, long-term injury surveillance system in youth football is essential for developing evidence-based interventions to reduce injury risk and support player development.