Key Points - Highly specialized youth athletes who have only ever played 1 sport had an injury distribution similar to that of highly specialized youth athletes who quit other sports to focus on a single sport. - Among highly specialized youth athletes, playing an individual sport was associated with a greater proportion of injuries due to overuse versus acute mechanisms when compared with playing a team sport. Abstract Context: Sport specialization, commonly defined as intensive year-round training in a single sport to the exclusion of other sports, has been associated with an increased risk for overuse injury. Two pathways to becoming highly specialized are recognized: (1) having only ever played 1 sport (exclusive highly specialized) and (2) quitting other sports to focus on a single sport (evolved highly specialized). Understanding the differences in injury patterns between these groups of highly specialized athletes will inform the development of injury-prevention strategies. Objective: To compare the distribution of injury types (acute, overuse, serious overuse) among evolved highly specialized athletes, exclusive highly specialized athletes, and low-moderately specialized athletes. Design: Cross-sectional study. Setting: Tertiary care pediatric sports medicine clinic between January 2015 and April 2019. Patients or Other Participants: A total of 1171 patients (age = 12.01-17.83 years, 59.8% female) who played =1 organized sports, presented with a sport-related injury, and completed a sports participation survey. Main Outcome Measure(s): Distribution of injury types (acute, overuse, serious overuse). Results: The percentage of injuries due to overuse was similar between the exclusive and evolved highly specialized athletes (59.2% versus 53.9%; P = .28). Compared with low-moderately specialized athletes, exclusive and evolved highly specialized athletes had a higher percentage of overuse injuries (45.3% versus 59.2% and 53.9%, respectively; P = .001). Multivariate analysis of the highly specialized groups revealed sport type to be a significant predictor of a higher percentage of injuries due to overuse, with individual-sport athletes having increased odds of sustaining an overuse injury compared with team-sport athletes (odds ratio = 1.95; 95% CI = 1.17, 3.24). Conclusions: The distribution of injury types was similar between evolved and exclusive highly specialized youth athletes, with both groups having a higher percentage of injuries due to overuse compared with low-moderately specialized athletes. Among highly specialized athletes, playing an individual sport was associated with a higher proportion of overuse injuries compared with playing a team sport.
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