Objective This study aimed to describe and compare the epidemiological injury patterns at the World Taekwondo Championships (WTC) in 2017 Muju, 2019 Manchester and 2022 Guadalajara, with consideration of changes in the competition rules. Methods A retrospective cohort study design using a modified injury surveillance system (ISS) was applied across three WTC events. Injury incidence proportion was computed and calculated both per 1000 athlete exposures and per 1000 minutes of exposure. Results Across the three events, 2663 athlete registrations and 4712 exposures were recorded. Injury incidence rates decreased from 13.49 (95% CI 11.18 to 15.80) per 100 athlete exposures in 2017 to 6.41 (95% CI 4.79 to 8.03) in 2019, before increasing to 8.60 (95% CI 6.51 to 10.69) in 2022. Injury patterns shifted, with fewer head and neck injuries and more upper extremity injuries. Severe injuries declined, with changes linked to revised rules, scoring systems and match formats. Male and heavyweight athletes consistently showed higher injury rates across all WTCs. Conclusion Our study revealed significant changes in injury profile across the three WTCs, coinciding with major competition rule modifications. Despite the overall decrease in injury incidence rates, variations in injury distribution associated with rule modifications were observed. The observed reduction in severe injuries and overall injury rates suggests enhanced athlete safety. However, these findings highlight the importance of ongoing assessment and refinement of competition rules, athlete preparation protocols and ISS to further confirm and improve the safety of taekwondo athletes.
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