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Context: Our understanding of the injury burden in elite adolescent athletes in most sports is limited or unknown because of the lack of prospective, long-term injury studies. Objective: To describe injury patterns in terms of type, location, prevalence and incidence, recurrence, and severity grade; time to first injury; and prevalence of illness in elite adolescent athletes and to compare differences in injury data by sex and sport type. Design: Cohort study. Setting: Fifteen national sports high schools in Sweden. Patients or Other Participants: Participants were 284 elite adolescent athletes (boys = 147, girls = 137; median age = 17 years; 25th-75th percentile range = 16-18 years) competing at a high national level for their age in athletics (track and field), cross-country skiing, downhill skiing, freestyle skiing, handball, orienteering, or ski orienteering. Main Outcome Measure(s): All athletes were monitored weekly over 52 weeks, using a validated online questionnaire to identify injury type, location, prevalence or incidence, and severity grade; time to first injury; and prevalence of illness. Results: Among all athletes, 57.4% reported at least 1 new injury, whereas the 1-year injury prevalence was 91.6%. The overall injury incidence was 4.1/1000 hours of exposure to sport, and every week, on average, 3 of 10 (30.8%) elite adolescent athletes reported being injured. Of all injuries from which athletes recovered, 22.2% (n = 35) resulted in absence from normal training for at least 2 months. Female athletes reported higher (P<.05) average weekly injury prevalence and substantial injury prevalence (injuries leading to a moderate or severe reduction in sport performance or participation or time loss) than male athletes. Conclusions: A considerable number of elite adolescent athletes were injured weekly, resulting in serious consequences for sport participation, training, or performance (or a combination of these). Appropriately designed interventions to prevent knee and foot injuries will target both the greatest number of injuries and the injuries with the most serious consequences in elite adolescent athletes.