Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Jersey sanctioned MMA events after requiring a series of rule changes. The purpose of this study was to determine the incidence of injury in professional MMA fighters. Data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Athletic Commission. Medical and outcome data from events were analyzed based on a pair-matched case-control design. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. A total of 171 MMA matches involving 220 different fighters occurred during the study period. There were a total of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) ended with at least one injured fighter. The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. Facial laceration was the most common injury accounting for 47.9% of all injuries, followed by hand injury (13.5%), nose injury (10.4%), and eye injury (8.3%). With adjustment for weight and match outcome, older age was associated with significantly increased risk of injury. The most common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out. The injury rate in MMA competitions is compatible with other combat sports involving striking. The lower knockout rates in MMA compared to boxing may help prevent brain injury in MMA events.

• Mixed martial arts (MMA) has changed since the first MMA matches in the United States and now has increased safety regulations and sanctioning.

• MMA competitions have an overall high rate of injury.

• There have been no MMA deaths in the United States.

• The knockout (KO) rate in MMA appears to be lower than the KO rate of boxing matches.

• MMA must continue to be supervised by properly trained medical professionals and referees to ensure fighter safety in the future.