Musculoskeletal Injury Incidence Among US Military Academy and Reserve Officer Training Corps Cadets: A Scoping Review

CONTEXT: Musculoskeletal injuries (MSKI) are a leading cause of limited-duty days and attrition among United States (US) service members (SMs). Nearly half of SMs sustain a MSKI each year, which has long-term impacts on SM health and wellbeing. Despite their similar physical and operational demands, the epidemiology of MSKI among US Service Academy (SA) and Reserve Officers' Training Corps (ROTC) cadets, a key precommissioning cohort, remains poorly characterized. The objective of this review was to map and synthesize available evidence describing the incidence and distribution of MSKI among US cadets and evaluate the strength of evidence across studies. EVIDENCE ACQUISITION: A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines. Eligible studies included English-language, US-based observational research involving cadets at SAs or ROTC programs. Searches were completed in PubMed, CINAHL, and Scopus through July 2025. Injury type, frequency, body region, and sex-specific incidence were extracted from each paper when available. Injury incidence was standardized per 1000 person-weeks to allow comparison across studies. Quality of evidence was appraised using the GRADE framework. STUDY DESIGN: Scoping review with quantitative incidence standardization and qualitative synthesis; GRADE ratings across included studies. LEVEL OF EVIDENCE: Level 3. RESULTS: A total of 34 studies met inclusion criteria, representing 27 to 24,501 cadets per cohort. Average MSKI incidence among SA cadets was 53.7 injuries per 1000 person-weeks, and 30.6 injuries per 1000 person-weeks among ROTC cadets. Lower extremity injuries predominated, with higher rates among female cadets. Evidence quality was rated as moderate in 10 studies, low in 16, and very low in 8. CONCLUSION: Cadets experience MSKI at rates similar to active-duty personnel, particularly during initial military training. These findings establish a benchmark for future injury prevention and readiness research and emphasize the importance of clinical injury surveillance protocols.Strength-of-Recommendation Taxonomy (SORT):B. Recommendation based on inconsistent or limited-quality patient-oriented evidence.