• Kabir Singh Lota, Nikos Malliaropoulos, Wiesław Blach, Takeshi Kamitani, Akira Ikumi, Vasileios Korakakis, and Nicola Maffulli.
• Barts and The London School of Medicine and Dentistry, London, E1 2AD, UK.
• Br. Med. Bull. 2022 Mar 21; 141 (1): 33-46.

BackgroundTraumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds.Sources Of DataPubMed, EMBASE, Web of Science, Cochrane Library and Scopus were searched from inception to 31st December 2021. Twenty-two studies presenting RA data from head impacts across boxing, taekwondo, judo, wrestling and MMA were included. The AXIS tool was used to assess the quality of studies.Areas Of AgreementRA was greater following direct head strikes compared to being thrown or taken down. RA from throws and takedowns was mostly below reported injury thresholds. Injury thresholds must not be used in the absence of clinical assessment when TBI is suspected. Athletes displaying signs or symptoms of TBI must be removed from play and medically evaluated immediately.Areas Of ControversyMethodological heterogeneity made it difficult to develop sport-specific conclusions. The role of headgear in certain striking sports remains contentious.Growing PointsRA can be used to suggest and assess the effect of safety changes in combat sports. Gradual loading of training activities based on RA may be considered when planning sessions. Governing bodies must continue to work to minimize RA generated from head impacts.Areas Timely For Developing ResearchProspective research collecting real-time RA data is required to further understanding of TBI in combat sports.© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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