The Summer and Winter Olympic and Paralympic Games are the pinnacle of many athletes' careers, yet few have been fully reported on regarding injury occurrence (Athanasopoulos et al. BJSM 2007;41:603). We collated the evidence on sports injuries at Olympic and Paralympic Games into a complete review to inform medical provision, injury prevention and data collection planning for future multi-sport events. Eight electronic databases were systematically searched for articles fulfilling the following criteria: (i) title regarding any Olympic or Paralympic Games competition or training period, (ii) abstract documenting the frequency, characteristics or causes of sports related injuries that (iii) occurred in participating athletes. Twelve articles met the inclusion criteria. Four included all athletes and injuries at the event investigated. In the 2008 Summer Olympics, 1055 injuries were reported from 9572 athletes, highest proportions in football and commonest location the knee. In the 2010 Winter Olympics, 287 injuries were reported from 2567 athletes, highest proportions in snowboard cross and commonest location the knee. In the 2010 and 2002 Winter Paralympics, injuries were reported from 120 of 505 and 39 of 416 athletes respectively, highest proportions in sledge hockey. Current evidence suggests a similar proportion of injuries in Summer and Winter Olympics, an inconclusive proportion in Winter Paralympics, and a lack of research on Summer Paralympics. Severe injuries occur in training and competition, so adequate medical cover is needed during both. Preventative strategies should be sport-specific as injury causalities vary (Engebretsen et al. BJSM 2010;44:772). To better understand emerging sport specific injury patterns, International Federations could consider collaboration to establish a prospective surveillance system to produce longitudinal evidence from future sporting events (Webborn et al. CJSM 2012;22:3).