Injuries and illnesses in the CONMEBOL Copa Libertadores and Copa Sudamericana men’s football tournaments 2022–2024

We aimed to describe the incidence and patterns of match injuries and illnesses in two elite South American men's football tournaments and explore associations with environmental and logistical factors. This prospective study included all Copa Libertadores and Copa Sudamericana matches from 2022 to 2024 (930 matches; 30,690 player-hours). Match injuries and illnesses leading to direct substitution were recorded by match doctors. Incidence rates (IR) per 1,000 player-hours with 95% confidence intervals (CI) were calculated. Poisson regression models examined associations between injury incidence and temperature, altitude, travel distance, and home vs. away status. A total of 359 injuries and 3 illnesses were reported (IR: 11.7 injuries per 1,000 h [95% CI: 10.5-13.0]). Muscle/tendon injuries were most frequent (58%; IR: 6.8 [95% CI: 5.9-7.9]), followed by ligament/joint injuries (23%; IR: 2.7 [95% CI: 2.2-3.4]) and concussions (9%; IR: 1.0 [95% CI: 0.7-1.5]). Hamstring strains accounted for 32% of all injuries (IR: 3.7 [95% CI: 3.1-4.5]). Injury incidence was similar across seasons and competitions. Muscle injury rates were lower at moderate and high altitudes, and overall injury rates were higher for home teams compared to away teams. No associations were found between temperature or travel distance and injury incidence rates. This is the largest epidemiological study of match injuries in elite South American football. Hamstring muscle injuries and concussions represented a higher relative proportion of injuries compared with European and Asian cohorts. Novel findings include potential protective effects of altitude and increased injury risk associated with home matches.