Background While effective programmes to prevent anterior cruciate ligament (ACL) injury have been established, it is important that programme design, consistent with the van Mechelen model, is based on the specific injury mechanisms, representative of the region and playing conditions. Presently, no such data exist for professional football players competing in the Middle East.

Objective To describe the mechanisms of ACL injury in male professional football players in the Qatar Star League (QSL) based on systematic video analysis.

Design Systematic video analysis of prospective injury surveillance data.

Setting Male professional football in Qatar.

Participants Fifteen professional male football players in the QSL, who sustained an ACL injury in a match during the seasons 2013/2014 through 2018/2019.

Assessment of injury mechanisms Injuries were recorded through the Aspetar Injury Surveillance Programme and high definition broadcast videos were analyzed (49 views; 34 slow motion). Five analysts independently described the injury mechanisms in detail (situation, behavior, biomechanical characteristics), using validated observational tools (Walden et al. 2015).

Results A knee valgus mechanism was observed in 10 cases (1 with direct contact to the knee, 3 with contact to other body part and 6 with no body contact), no valgus was observed in 2 cases (both direct knee contact), while 3 were unclear. Of the 12 non-contact/indirect-contact situations, we saw 4 main categories of injury situations (multiple combinations were possible): pressing (n=6), tackling or to be tackled by another player (n=4), blocking (n=3) and screening (n=2). In the 3 direct contact injuries, the player was tackling in 2 cases and being tackled by another player in 1 case.

Conclusions Only 20% of match ACL injuries were contact injuries. Knee valgus was consistently observed, independent of the playing situation. Pressing was the main mechanism leading to injury. Landing after heading was not observed in any of these injuries.