<p>The effects of injury and illness on sports performance remain incompletely understood in Olympic athletes. This study investigated whether sustaining an injury or illness at the 2024 Paris Summer Olympic Games affected the probability of winning a medal, which combinations of injuries or illnesses were most impactful on the probability of winning a medal, and how injury or illness influenced athletes’ final percentile ranking. Data from injury and illness events among Team USA athletes were merged with final event results and <i>ex ante</i> (i.e., based on forecasts) market-derived probabilities of success. Logistic and general linear regression models were used to assess the impact of injury and illness on outcomes, controlling for the expected probability of success. Results showed no significant effect of injury or illness on the probability of medaling (<i>p</i> = 0.945). However, sustaining an injury or illness was significantly associated with a lower percentile rank finish (<i>p</i> = 0.004), with a stronger effect among athletes with lower initial probabilities of success (<i>p</i> = 0.013). These findings highlight the measurable impact of injury and illness beyond only time loss and reinforce the importance of robust injury and illness prevention strategies for elite athletes.</p>