Background The mechanisms of acute ankle syndesmosis ligament injuries in professional rugby union are not well understood.
Aim To describe the mechanisms of acute ankle syndesmosis ligament injuries in male professional rugby union players using systematic visual video analysis.
Methods All time-loss acute ankle syndesmosis ligament injuries identified via retrospective analysis of the Leinster Rugby injury surveillance database across the 2013/2014 to 2017/2018 seasons were considered as potentially eligible for inclusion. Three Chartered Physiotherapists (analysts) independently assessed all videos with a final consensus meeting convened to describe the injury mechanisms. One of the analysts developed a qualitative description of each injury mechanism.
Results Thirteen acute ankle syndesmosis injuries were included in this study. The most common biomechanical presentation of the injured limb was characterised by hip flexion, knee flexion, knee valgus, ankle dorsiflexion, pronation and external rotation of the foot. Six of the included injuries (46%) were the result of an external load application to the injured limb (ie, direct contact injuries). In the other seven instances (54%), the injury was the result of a collapse of the injured player’s body mass over the injured ankle joint, while tackling or being tackled, without direct contact to the injured limb (ie, indirect contact injuries).
Conclusion Injuries incurred while tackling were exclusively the result of suboptimal tackle mechanics. A majority of injuries incurred while being tackled involved a posterior tackle, which often resulted in a posterior collapse of the injured player’s centre of mass over a fixed externally rotated foot.
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Contributors ED, GF, AB, FK and CB co-developed the idea for the study. AB and PT sourced data for the study. FK developed the injury assessment form and ED and GF approved it. ED, AB, GF and HH analysed all the videos and reached consensus on the details of the injury assessment forms. FK mediated the consensus meeting. ED developed the qualitative description of each injury case (supplementary file 1). ED and AB drafted the initial manuscript, which as edited and agreed upon by all authors.
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 Professor ED is a Senior Associate Editor of the British Journal of Sports Medicine.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Ethical approval was received from the University College Dublin Human Research Ethics Committee (LS-19-18-Delahunt).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Data are available upon reasonable request.
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