Associations between maturation assessment methods and growth-related injury occurrence in a German Bundesliga youth football academy

Peak height velocity (PHV) marks a sensitive period for adolescent athletes with increased injury risk. This prospective observational study explores how different maturation assessment methods are associated with injury occurrence, particularly growth-related injuries, during PHV in elite youth football players. Maturation of male U9-U16 players from the academy of a German Bundesliga club was assessed four times over one year using nine different methods (Mirwald, Moore, Fransen: ± 6/12 months, Khamis-Roche 85–96%/88–96%, ultrasonic BAUSport). Maturation was categorised into three periods relative to players’ PHV (Pre-PHV, PHV, Post-PHV). For each assessment-quarter, injury occurrence was categorised as no injury, growth-related, non-contact, or contact. Injury occurrence across maturation periods was analysed in a Bayesian multinomial regression using data from 205 players (619 assessments). In this single-academy cohort, only the ultrasonic BAUSport-defined PHV period was associated with higher odds of growth-related injury, as results reveal lower odds versus no injury in Pre- and Post-PHV periods (OR = 0.33 and 0.17) relative to PHV. Most methods demonstrated higher odds of non-contact injury versus no injury with progressive maturation, while contact injuries did not differ between maturation periods. This preliminary association warrants evaluation in larger longitudinal cohorts with exposure data before informing monitoring or prevention practice. Clinical trial registration: The study was registered at the German Clinical Trial Register ( www.drks.de ; DRKS00036919).