Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases

Abstract

BackgroundCurrent knowledge on anterior cruciate ligament (ACL) injury mechanisms in male football players is limited.AimTo describe ACL injury mechanisms in male professional football players using systematic video analysis.MethodsWe assessed videos from 39 complete ACL tears recorded via prospective professional football injury surveillance between 2001 and 2011. Five analysts independently reviewed all videos to estimate the time of initial foot contact with the ground and the time of ACL tear. We then analysed all videos according to a structured format describing the injury circumstances and lower limb joint biomechanics.ResultsTwenty-five injuries were non-contact, eight indirect contact and six direct contact injuries. We identified three main categories of non-contact and indirect contact injury situations: (1) pressing (n=11), (2) re-gaining balance after kicking (n=5) and (3) landing after heading (n=5). The fourth main injury situation was direct contact with the injured leg or knee (n=6). Knee valgus was frequently seen in the main categories of non-contact and indirect contact playing situations (n=11), but a dynamic valgus collapse was infrequent (n=3). This was in contrast to the tackling-induced direct contact situations where a knee valgus collapse occurred in all cases (n=3).ConclusionsEighty-five per cent of the ACL injuries in male professional football players resulted from non-contact or indirect contact mechanisms. The most common playing situation leading to injury was pressing followed by kicking and heading. Knee valgus was frequently seen regardless of the playing situation, but a dynamic valgus collapse was rare.

Effectiveness of Accelerated Rehabilitation for Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction in Football Players

“…On average, one player will suffer an ACL injury every second season in a professional men's football team squad [2]. Serious injuries have not dropped in men's professional football in the past decade, and prevention of ACL injury is a priority area within sports medicine research [1]. Despite significant advances in the diagnostics and treatment of knee injuries over the last decade, several challenges related to 'return to sport' remain largely unknown.…”

“…Anterior cruciate ligament (ACL) injury in professional athletes can cause long lay-off from sports and may be career threatening [1]. On average, one player will suffer an ACL injury every second season in a professional men's football team squad [2].…”

Anterior Cruciate Ligament Insufficiency: Delay in Surgery and Its Association with Spectrum of Intraarticular Knee Lesions

“…Despite a 'typical' mechanism of injury leading to ACL rupture [6][7][8] , poor rate of initial diagnosis, delay in surgery & its consequences are extremely common [9][10][11] . Concurrent Meniscal and Chondral Injuries in ACL injured knees has been reported by many authors [12][13][14][15][16][17][18][19][20][21] and remains a major cause of concern and prognostic factor in long term results [3][4][5] .…”

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION & THE HAMSTRINGS Implications for injury prevention & rehabilitation

“…Studies have shown that men and women display different responses during a fatiguing task and that the magnitude of sex differences is task specific (Hunter, 2009). In professional soccer, fatigue seems to be an unlikely risk factor for ACL ruptures, because most injuries are sustained in the first half or soon after players enter a match (Walden et al, 2015). More prospective studies investigating the effects of fatigue on ACL injury risk are warranted.…”

“…Walden and colleagues (2006) showed that 50 % of athletes with a history of ACL injury and subsequent reconstruction go on to suffer an overuse knee injury such as bursitis, tendinitis or patellofemoral pain syndrome. This suggests greater care should be taken from early to late stage rehabilitation to ensure successful recovery before players return to competition in their respective sports (Walden et al, 2015). It may be that after ACLR, persistent neuromuscular and biomechanical risk factors occur which render athletes at greater risk of future re-injury (Alentorn-Geli et al, 2009a;Hewett et al, 1999;Hewett et al, 2006;Mandelbaum et al, 2005).…”