Musculoskeletal Injury Incidence Among US Military Academy and Reserve Officer Training Corps Cadets: A Scoping Review
Sports health · 2026
Cadets get hurt at rates rivaling active-duty troops, but most of the underlying evidence is low quality, so treat the numbers as a rough benchmark, not a precise estimate.
Part of: Training load and injury risk: what the evidence says · Injury prevention and screening in sport · Female athlete health: the evidence base
The paper
Scoping review, 34 studies (n=27 to 24,501 cadets per cohort) of musculoskeletal injury incidence among US Service Academy and ROTC cadets.
What they found
Average MSKI incidence was 53.7 per 1000 person-weeks in Service Academy cadets versus 30.6 per 1000 person-weeks in ROTC cadets; lower extremity injuries predominated and female cadets had higher rates than males. No pooled effect size, confidence interval, or statistical test was reported for these comparisons.
Study design
PRISMA-ScR scoping review (self-rated Level 3 evidence) synthesizing 34 heterogeneous observational studies of varying cohort sizes, searched across PubMed, CINAHL, and Scopus through July 2025.
Methodology
The search and extraction process is transparent and GRADE was applied to each included study, but the headline incidence figures are simple averages across studies with wildly different sample sizes (27 to 24,501), follow-up periods, injury definitions, and settings, with no apparent weighting for precision, so a few large or small studies could skew the pooled number. Evidence quality across the included studies was mostly poor: 0 rated high, 10 moderate, 16 low, and 8 very low, meaning most of the underlying data have real risk of selection, detection, or reporting bias. Scoping reviews by design don't exclude on quality or compute a true pooled estimate, so this is best read as a structured narrative map rather than a precise incidence estimate; a clinician wanting to verify the 53.7 vs 30.6 figures would need to check how many of the 34 studies actually reported person-week denominators and whether sparse-data cohorts were given equal weight.
The appraisal
This is a descriptive epidemiology exercise, not a test of an intervention, so there is no causal or comparative claim to assess, just a benchmark figure assembled from mostly low and very-low quality source studies. Worth flagging: GRADE was built to rate confidence in intervention effect estimates, not descriptive incidence rates, so grading a scoping synthesis of heterogeneous surveillance designs this way signals rigour without mapping cleanly onto what's actually being measured. The SA-versus-ROTC gap (53.7 vs 30.6/1000 person-weeks) and the female-male gap are plausible given known military training literature, but without CIs or adjustment for training phase, climate, or surveillance intensity across studies, the precision implied by one decimal place is probably false.
The gap
There is no sensitivity analysis or quality-stratified estimate, so it is unclear how much the pooled incidence figures would shift if the 8 very-low-quality studies were dropped; that is the number to ask for before citing 53.7 or 30.6 as a true rate.
Landmark context
This extends the broader US military basic-training injury surveillance literature (the kind of work associated with researchers like Knapik and Jones on recruit injury epidemiology, and Cameron KL's prior ACL/military injury work) into the under-studied precommissioning cadet population, rather than overturning any single landmark trial.
What to do Monday
This doesn't change Monday's clinical management of an individual cadet; its value is for program-level injury surveillance and prevention planning, where it flags lower extremity injury and female sex as priority targets for screening and load monitoring in cadet populations.
In practice
This is program-level data, not an individual prescription: if you work with SA or ROTC cadets, use it to justify building a basic injury surveillance log (by week, body region, sex) rather than guessing at your unit's actual risk. On the S&C floor, front-load slower, more progressive lower-body volume in the first weeks of basic or initial training, when overuse injury clusters, and watch female cadets' training volume more closely given the consistent sex gap, without assuming it's purely biological rather than a mismatch between prior training exposure and programmed load. In the clinic, this raises your index of suspicion for lower-extremity bone stress injury and tendinopathy in cadets early in a training cycle, which should lower your threshold for imaging or referral rather than a wait-and-see approach. The caveat in applying it: 53.7 and 30.6 are benchmark averages pulled from very mixed-quality studies, not your cohort's actual rate, so collect your own numbers before changing programming and don't quote these figures as precise to a commander or coach.
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