Off-road motorcycling is one of the most popular sports activities practiced by millions of people in the world but little has been written on motocross traumatology and its prevention. This paper aims to evaluate motocross injuries in terms of injury ratio, location, causes, and possible prevention in a series of competitions organized by Motorcyclistic Federations over a 12-year period. We retrospectively evaluated 1,500 accidents with 1,870 rider injuries out of a group of 15,870 athletes participating in European off-road competition from 1980 to 1991. Data were collected from race medical reports, insurance declarations and follow-up forms filled up by riders involved in accidents. We then classified the type and location of the injury, modality of the accident, the protective gear used and the recovery of the riders. We compared our data to lesions noted in motorcycle road races using the chi-square test and the z-test. The overall incidence of motocross injuries in our study was 94.5 per thousand, while stadium cross competitions had a 150 per thousand rate and outdoor motocross a rate of 76 per thousand representing a risk of accident of 22.72 per thousand hours of riding. Among the total of 1,870 injuries, 1076 were bruises; 27.9% of these were in the upper extremities, 26.9% on the lower, 21.2% on the trunk, and 16% on the face. There were 450 fractures recorded, 50.9% in the upper extremities, 38% in the lower, and the rest were on the spine, chest, and skull. The 26 spine fractures (5.8%) produced permanent neurologic sequelae in eight patients. Ligamentous lesions accounted for 344 cases with 206 (59.9%) occurring in the lower extremities especially on the knee (42.4%). Head trauma was noted in 86 cases (5.7% of accidents) producing coma in 3%, and loss of consciousness in 14%. Limb involvement for all types of injuries were more frequent on the left side (60%). Motocross is a high-risk sport: our study revealed the most common modalities and types of lesions sustained by the riders. Despite the reduction of some injuries by better protective gears, the occurrence of knee sprain, and wrist and clavicular fractures are still high. Furthermore, the high number of spine lesions with subsequent neurologic deficit noted in indoor races raises doubts about the safety of these events.