Abstract Off-road motorcycling is one of the most popular sports activi- ties practiced by millions of people in the world but little has been writ- ten on motocross traumatology and its prevention. This paper aims to evaluate motocross injuries in terms of injury ratio, location, causes, and possible prevention in a series of competitions organized by Motorcy- clistic Federations over a 12-year pe- riod. We retrospectively evaluated 1,500 accidents with 1,870 rider in- juries out of a group of 15,870 ath- letes participating in European off- road competition from 1980 to 1991. Data were collected from race med- ical reports, insurance declarations and follow-up forms filled up by rid- ers involved in accidents. We then classified the type and location of the injury, modality of the accident, the protective gear used and the recovery of the riders. We compared our data to lesions noted in motorcycle road races using the chi-square test and the z-test. The overall incidence of motocross injuries in our study was 94.5‰, while stadium cross competi- tions had a 150‰ rate and outdoor motocross a rate of 76‰ represent- ing a risk of accident of 22.72‰ hours of riding. Among the total of 1,870 injuries, 1076 were bruises; 27.9% of these were in the upper ex- tremities, 26.9% on the lower, 21.2% on the trunk, and 16% on the face. There were 450 fractures recorded, 50.9% in the upper extremities, 38% in the lower, and the rest were on the spine, chest, and skull. The 26 spine fractures (5.8%) produced permanent neurologic sequelae in eight patients. Ligamentous lesions accounted for 344 cases with 206 (59.9%) occur- ring in the lower extremities espe- cially on the knee (42.4%). Head trauma was noted in 86 cases (5.7% of accidents) producing coma in 3%, and loss of consciousness in 14%. Limb involvement for all types of in- juries were more frequent on the left side (60%). Motocross is a high-risk sport: our study revealed the most common modalities and types of le- sions sustained by the riders. Despite the reduction of some injuries by better protective gears, the occur- rence of knee sprain, and wrist and clavicular fractures are still high. Furthermore, the high number of spine lesions with subsequent neuro- logic deficit noted in indoor races raises doubts about the safety of these events. Keywords Motocross injuries · Off-road motorcycling · Sport specific injuries · Sport prevention · Knee brace SPORTS MEDICINE Knee Surg Sports Traumatol Arthrosc (2004) 12 : 574–580 DOI 10.1007/s00167-004-0510-z Alberto Gobbi Benjamin Tuy Ian Panuncialman The incidence of motocross injuries: a 12-year investigation Received: 1 March 2003 Accepted: 26 January 2004 Published online: 5 May 2004 © Springer-Verlag 2004 A. Gobbi (✉) · B. Tuy · I. Panuncialman Orthopedic Arthroscopic Surgery International, Via Amadeo 24, 20133 Milan, Italy Tel.: +39-02-7610310, Fax: +39-02-70124931, e-mail: sportmd@tin.it