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Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases
  1. Francesco Della Villa1,
  2. Matthew Buckthorpe1,
  3. Alberto Grassi2,
  4. Alberto Nabiuzzi1,
  5. Filippo Tosarelli1,
  6. Stefano Zaffagnini2,
  7. Stefano Della Villa1
  1. 1 Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
  2. 2 IIa Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli Istituto di Ricovero e Cura a Carattere Scientifico, Bologna, Emilia-Romagna, Italy
  1. Correspondence to Dr Francesco Della Villa, Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy; f.dellavilla{at}


Background A few small studies have reported on the mechanisms of ACL injury in professional male football.

Aim To describe the mechanisms, situational patterns and biomechanics (kinematics) of ACL injuries in professional male football matches.

Methods We identified 148 consecutive ACL injuries across 10 seasons of professional Italian football. 134 (90%) injury videos were analysed for mechanism and situational pattern, while biomechanical analysis was possible in 107 cases. Three independent reviewers evaluated each video. ACL injury epidemiology (month), timing within the match and pitch location at the time of injury were also reported.

Results 59 (44%) injuries were non-contact, 59 (44%) were indirect contact and 16 (12%) were direct contact. Players were frequently perturbed immediately prior to injury. We identified four main situational patterns for players who suffered a non-contact or an indirect contact injury: (1) pressing and tackling (n=55); (2) tackled (n=24); (3) regaining balance after kicking (n=19); and (4) landing from a jump (n=8). Knee valgus loading (n=83, 81%) was the dominant injury pattern across all four of these situational patterns (86%, 86%, 67% and 50%, respectively). 62% of the injuries occurred in the first half of the matches (p<0.01). Injuries peaked at the beginning of the season (September–October) and were also higher at the end of the season (March–May).

Conclusions 88% of ACL injuries occurred without direct knee contact, but indirect contact injuries were as frequent as non-contact injuries, underlying the importance of mechanical perturbation. The most common situational patterns were pressing, being tackled and kicking.

  • anterior cruciate ligament
  • biomechanics
  • football
  • injury prevention
  • knee ACL

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  • Contributors FDV, MB and AG contributed to the ideation of the study. AN and FT supported the data collection. FDV, MB and AG undertook the video analysis. FDV, MB, AG, AN, FT, SZ and SDV provided intellectual contribution to the writing and drafting of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All the videos we accessed are publicly available, data were treated confidentially, and no personal player information was accessed, and therefore ethical permission was not required. Injured players' privacy was respected and no personal information has been published.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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