OBJECTIVE: To describe and identify predictors of 12-month outcomes of serious orthopaedic injuries due to sport and active recreation. DESIGN: Prospective cohort study with 12-month follow-up. SETTING: Two Level 1 adult trauma centers in Victoria, Australia. PARTICIPANTS: A total of 366 adults admitted to two Level 1 trauma centers for an orthopaedic sport and active recreation injury between August 2003 and March 2006. Patients were captured by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), followed up at 12 months, and were free of moderate to severe disability prior to injury. ASSESSMENT OF RISK FACTORS: Independent variables assessed for predictors of outcome were sporting group, age, sex, marital status, education level, Injury Severity Score, injury patterns, and head injury status. MAIN OUTCOME MEASUREMENTS: The 12-item Short Form Health Survey and maximum pain scores. RESULTS: At 12 months postinjury, 22.8% of patients reported moderate to severe physical disability, 12.1% reported moderate to severe mental health disability, and 11.1% reported moderate to severe pain. There were significant differences in physical outcomes between sporting groups, with motor and equestrian sports reporting the worst physical outcomes. Multivariate analysis indentified increasing age (P = 0.010) and patterns of injury (P = 0.040) as significant predictors of a poor physical outcome at 12 months. No significant independent predictors of outcome for mental health and maximum pain at 12 months were identified. CONCLUSION: Almost one-quarter of participants reported moderate to severe physical disability at 12 months postinjury. Increasing age and patterns of injury were found to be significant predictors of a poor physical outcome at 12 months.