Severe injuries in competitive cycling during an olympic cycle: injury patterns, time loss, and return-to-performance outcomes

Background Cycling is an established Olympic sport associated with a distinct injury profile that has not yet been comprehensively investigated. This study aimed to retrospectively assess and analyze severe cycling-related injuries resulting in ≥ 3 weeks of time loss over a complete Olympic cycle. Methods A total of 192 cyclists were included, based on a retrospective online questionnaire assessing injury location, type, context, time loss, and return-to-sport outcomes. Data were analyzed using descriptive statistics, Chi-square tests, Mann–Whitney U tests, and exact tests (Fisher/Fisher–Freeman–Halton). Results Seventy-two of 192 athletes sustained at least one severe injury, corresponding to a 5-year period prevalence of 37.5%. A total of 237 injuries were recorded, with the upper extremity (33.8%) and lower extremity (27.8%) being the most frequently affected regions. Hand fractures (n = 14), clavicle fractures (n = 13), and non-specific knee injuries (n = 9) were the most common diagnoses. Significant discipline-specific differences were observed for hand fractures (p = 0.038) and shoulder dislocations (p = 0.046), while hand fractures also occurred more frequently in competitive athletes (p = 0.040). Clavicle fractures occurred predominantly during competition, whereas non-specific knee injuries were mainly training-related. Mean time loss ranged from 6.5 weeks for hand fractures to 13.3 weeks for shoulder dislocations. Return to pre-injury performance varied markedly, from 85.7% after hand fractures to 28.6% after acromioclavicular joint separations. Conclusion Severe cycling injuries follow two main patterns: competition-related traumatic injuries of the upper extremity and training-associated overuse injuries. Discipline-specific differences in hand and shoulder injuries highlight the need for targeted prevention strategies. The discrepancy between return to sport and full return to performance, particularly after acromioclavicular joint injuries, emphasizes the importance of sport-specific rehabilitation approaches.