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Background <p>Anterior cruciate ligament (ACL) injuries are common in many sports and impose substantial performance and long-term health burdens. A quantitative synthesis of real-world, video-identified game situations can inform sport-specific prevention methods.</p> Objective <p>The aim of the study was to identify game situations and movement patterns leading to ACL injury in different sports.</p> Design <p>Systematic review with meta-analysis.</p> Data Sources <p>PubMed, Google Scholar, Web of Science, and Scopus were searched for studies analyzing video recordings of ACL injuries sustained by athletes of any sex during training or competition. Random effects meta-analyses of prevalence and moderator analyses (sport as a factor) were performed.</p> Results <p>In total, 39 articles (1551 video-verified ACL injuries) of on-average moderate quality (Quality Appraisal for Sports Injury Video Analysis Studies [QA-SIVAS]) scale mean 66%) were included. Noncontact (<i>n</i> = 745), indirect contact (<i>n</i> = 533), and direct contact (<i>n</i> = 273) mechanisms were reported, with notable sport-specific differences. Across all injuries, the most frequent contexts were ball action (45.7%), pressing/tackling (40.9%), and cutting (36.6%). Within noncontact cases, cutting (53.8%), pressing/tackling (50.2%), decelerating (38.9%), and landing (30.1%) were the most prevalent actions, whereas being tackled was most frequent in indirect contact cases (56.1%). For direct contact injuries, pooled action-specific estimates were available for being tackled (23.9%) and pressing/tackling (24.2%). Injuries typically occurred at high horizontal speed (53.8%; noncontact 70.7%), were more frequent during ball possession (67.5%) and offensive play (55.4%), and happened more early in time within the first 25% of the game in football (37.5%) and netball (37.8%).</p> Conclusions <p>The identified patterns support the use of mechanism-specific, sport-tailored prevention strategies (e.g., technique/strength, neurocognitive functioning for noncontact, perturbation-based drills for indirect contact, and rules/choice of equipment for knee-directed contact). Methodological improvements, such as harmonized and more detailed injury reporting, are needed to refine risk estimates.</p>

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Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Patrick Mai,
  • Steffen Willwacher,
  • Lina Rahlf,
  • Tim Hoenig,
  • Luca Braun,
  • Carlo von Diecken,
  • Kevin Bill,
  • Dominik Fohrmann,
  • Tron Krosshaug,
  • Karsten Hollander,
  • Thomas Gronwald,
  • Jan Wilke

摘要

Background

Anterior cruciate ligament (ACL) injuries are common in many sports and impose substantial performance and long-term health burdens. A quantitative synthesis of real-world, video-identified game situations can inform sport-specific prevention methods.

Objective

The aim of the study was to identify game situations and movement patterns leading to ACL injury in different sports.

Design

Systematic review with meta-analysis.

Data Sources

PubMed, Google Scholar, Web of Science, and Scopus were searched for studies analyzing video recordings of ACL injuries sustained by athletes of any sex during training or competition. Random effects meta-analyses of prevalence and moderator analyses (sport as a factor) were performed.

Results

In total, 39 articles (1551 video-verified ACL injuries) of on-average moderate quality (Quality Appraisal for Sports Injury Video Analysis Studies [QA-SIVAS]) scale mean 66%) were included. Noncontact (n = 745), indirect contact (n = 533), and direct contact (n = 273) mechanisms were reported, with notable sport-specific differences. Across all injuries, the most frequent contexts were ball action (45.7%), pressing/tackling (40.9%), and cutting (36.6%). Within noncontact cases, cutting (53.8%), pressing/tackling (50.2%), decelerating (38.9%), and landing (30.1%) were the most prevalent actions, whereas being tackled was most frequent in indirect contact cases (56.1%). For direct contact injuries, pooled action-specific estimates were available for being tackled (23.9%) and pressing/tackling (24.2%). Injuries typically occurred at high horizontal speed (53.8%; noncontact 70.7%), were more frequent during ball possession (67.5%) and offensive play (55.4%), and happened more early in time within the first 25% of the game in football (37.5%) and netball (37.8%).

Conclusions

The identified patterns support the use of mechanism-specific, sport-tailored prevention strategies (e.g., technique/strength, neurocognitive functioning for noncontact, perturbation-based drills for indirect contact, and rules/choice of equipment for knee-directed contact). Methodological improvements, such as harmonized and more detailed injury reporting, are needed to refine risk estimates.