## 4 Discussion
### The Role of Biological Maturity in Injury Risk Identification  
Although not significant in the present dataset, pre-pubertal athletes might be more at risk for traumatic injuries compared to post-pubertal athletes, as at least a tendency was observed. This finding seems plausible, since [PERSON] et al. [33] showed that anthropometric characteristics such as rapid growth rates and BMI increase seem to identify youth athletes at high injury risk; this seems particularly true between the year before PHV and the year of PHV [9; 11]. Additionally, [PERSON] et al. [34] found the adolescent growth spurt to be a time of an increased risk for sports injuries; an association between PHV and peak fracture rate was found. [PERSON] et al. [35] additionally revealed that growth plate tissue may be more vulnerable to injury during periods of rapid growth, which means that athletes are more susceptible to injuries during rapid phases of growth, which might be true for pre-pubertal as well as pubertal athletes but not for post-pubertal athletes. Growth spurts might lead to changes in the ratios of muscle strength to body or limb mass and moments of inertia; soft tissues may sustain increased stress and strain [36]. Individual monitoring of anthropometrics and corresponding growth spurts is necessary to determine an increased risk of injury occurrence [36]. Regular assessments of anthropometric characteristics, e.g., all three months, should be performed in order to be able to consider growth rates in future studies, which is especially important for the age group of athletes prior to or at the beginning of puberty [37; 38].  
In contrast to traumatic injuries, a tendency was present that post-pubertal athletes might be more prone to overuse injuries. Previous findings in youth ski racing identified _lighter_ athletes at a higher injury risk [6]. Thus, the present results revealing a significant higher injury risk in athletes being in the higher weight percentile group compared to the lower percentile group (OR = 0.38) was surprising and cannot really be explained. It should be noted in this context that unlike previous studies, the present GEE analysis does not exclusively compare heavier versus lighter athletes (due to repeated measurements across athletes). This approach may consider intra-individual fluctuations over the four seasons, e.g., comparing not only between separate athlete groups, but also between different time points, where athletes fall into different weight percentiles.  
Previous studies in soccer [11; 12] and youth ski racing [6] showed that late maturing athletes were at a higher risk for sustaining traumatic and overuse injuries, whereas in the present study, no significant difference in injury risk for both types of injuries was identified between early, normal, and late maturing athletes. However, in the study of [PERSON] et al. [6], an association was identified only between APHV and injury severity; namely, athletes with lower APHV values, which means that they are earlier maturing, were more likely to miss fewer days of training due to injuries. In the present study, injury severity was not considered in identifying risk factors, which means that minimal, mild, moderate, and severe injuries were included combined. However, the results are in line with those of [PERSON] et al. [6] showing no difference in injury risk in general (injured or not) between different maturity groups. With respect to overuse injuries, the unexpected finding that a tendency was present for _early_ maturing athletes being at a higher risk was found. Even though this result cannot really be explained, as previous studies in soccer showed a higher risk of sustaining overuse injuries for late maturing athletes [11], it leads to the assumption that traumatic and overuse injuries should be considered separately when talking about injury risk among athletes of differing maturity statuses.