How Risky Is Mixed Martial Arts? Injury Rates and Patterns in Competitive Versus Recreational Athletes

<b>Background/Objectives</b>: Mixed martial arts (MMA) is a popular full-contact combat sport. The aim of this study was to determine injury mechanisms, rates, severity, patterns, circumstances, and the resulting economic healthcare consequences by conducting a detailed survey of competitive and recreational athletes. <b>Methods</b>: In 2023, MMA athletes were retrospectively questioned regarding their injuries in the last 24 months and the resulting healthcare impact (medical attention, hospitalization, incapacity to work). An injury was defined as any physical complaint resulting from MMA exposure. The severity of the injury was categorized according to the resulting restriction of sport participation (i.e., 'severe': more than four weeks of restriction). <b>Results</b>: A total of 112 participants (93% male; 41% non-competitive and 59% competitive) were included. All in all, 93,857 h of MMA activities were performed, and 127 injuries were recorded, resulting in an overall injury rate of 1.4 injuries per 1000 h of exposure. Non-competitive athletes reported significantly fewer total injuries in the past 24 months (95% CI 0.87-2.04; <i>p</i> = 0.003) and had significantly fewer severe or even critical injuries compared to competitive athletes (OR 0.55; 95% CI 0.21-1.43; <i>p</i> = 0.042). Head- and neck lesions (20%) were the most common injuries. The most common types of injury were joint sprains (21%) and ligament strains (17%). The healthcare burden of these sports-related injuries was minimal: By median, injuries led to zero days of hospitalization and incapacity to work, with no statistically significant differences between recreational and competitive athletes. <b>Conclusions</b>: Competitive athletes suffer more severe injuries compared to recreational athletes. Overall, injuries in MMA are rare, and the economic impact and burden on the healthcare system are negligible compared to other sport disciplines.