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Background: Young female athletes may have higher rates of overuse injuries and sport specialization than male athletes. The association of sports specialization and return to sport (RTS) timeframe is also unknown., Hypothesis: Specialized female athletes will have more intense, year-round training patterns, more overuse injuries, and longer RTS times than male athletes., Study Design: Cohort study., Level of Evidence: Level 3., Methods: Injured athletes aged 10 to 23 years presenting to a sports medicine clinic reported their degree of sport specialization and training patterns. Skeletal maturity was estimated using the Khamis-Roche method. Injury type and RTS timeframes were categorized from electronic medical records. Chi-square tests and logistic regression analysis assessed associations between variables., Results: A total of 485 athletes (40.2% female) were enrolled. Higher degrees of sport specialization were associated strongly with overuse injuries ( P < 0.01). After adjusting for specialization, female athletes were more likely to sustain an overuse injury (adjusted odds ratio, 1.49; P = 0.04). Female athletes participated in fewer total physical activity hours per week ( P < 0.01), fewer free play hours per week ( P < 0.01), and participated in their main sport for more months of the year than their male counterparts ( P = 0.02). Female athletes were more likely to be at a higher developmental stage than male athletes ( P < 0.01). RTS timeframes were increased in athletes with serious overuse injury; however, no association was found between degree of specialization and RTS time regardless of sex., Conclusion: Female athletes are more likely to sustain overuse injuries with more organized, year-round, training and less free play compared with their male counterparts., Clinical Relevance: Female sex may be an independent risk factor of overuse injury. Future strategies to mitigate these risks may include increased free play hours and limiting year-round training through seasonal rest., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Background: Overuse injuries in youth athletes are associated with risks, including sports specialization, biological maturation, female sex, and workload measures. As no assessment tool exists to evaluate risk accumulation, we developed a novel risk factor scoring system (Sport Training Assessment of Risk [STAR]) to assess participants' risk of overuse injury and explore association with return-to-play (RTP) time periods., Hypothesis: (1) STAR will reach an acceptable predictive threshold in the assessment of overuse injury in youth athletes. (2) Higher STAR scores will be associated with increased RTP time periods after injury., Study Design: Longitudinal cohort study., Level of Evidence: Level 3., Methods: Youth athletes with an injury sustained during competitive sport completed questionnaires. Association of questionnaire variables with injury risk type was evaluated via logistic regression analyses, and unweighted and weighted versions of a total risk score were developed. RTP was defined by physician clearance per electronic medical record review. Mantel-Haenszel chi-square tests and Kendall's rank correlation coefficients were used to assess the relationship between weighted total risk score and RTP time periods. The weighted STAR model was analyzed with receiver operating characteristic (ROC) curves., Results: The weighted STAR model trended toward an acceptable level of prediction for overuse (nonserious + serious) injury (area under the ROC curve [AUC], 0.66; 95% CI, 0.61-0.71), but was less predictive for serious overuse injury (AUC, 0.63; 95% CI, 0.55-0.71). Weighted total risk score was weakly associated with return to full play (ρ = 0.11; P < 0.01), and potentially with return to modified play (ρ = -0.08; P = 0.04)., Conclusion: STAR may be a feasible tool for assessing overuse injury risk and RTP time periods in youth athletes but requires further development, as it did not reach an acceptable predictive threshold in this preliminary study., Clinical Relevance: Clinicians can use STAR to assess overuse injury risk in youth athletes., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.