Video Analysis of Acute Lower Extremity Injury Mechanisms in Soccer Demonstrates Most Anterior Cruciate Ligament, Achilles, and Muscle Injuries Occur Without Direct Contact: A Systematic Review and Meta-Analysis.
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Video Analysis of Acute Lower Extremity Injury Mechanisms in Soccer Demonstrates Most Anterior Cruciate Ligament, Achilles, and Muscle Injuries Occur Without Direct Contact: A Systematic Review and Meta-Analysis. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2025Abstract
To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players.The study was pre-registered on PROSPERO. PRISMA guidelines were followed. Three databases were searched for Level I-IV studies that quantified lower extremity injury mechanisms in soccer players using video analysis. Data recorded included study demographics, injury type, mechanisms, contact, phase of play, timing, and sagittal plane kinematics. Study methodological quality was analyzed using the Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) Scale. Forest plots of proportions were generated for injuries occurring in the first versus second half, defensive versus offensive phase, and contact versus noncontact injury.Nineteen articles (mean QA-SIVAS score 14.3 + 1.9; all Level IV evidence, 1,652 videos, 17 professional male, 1 professional female, 1 both male/female) were included. Anterior cruciate ligament (ACL) tears (49% [42% - 55%]), muscle strains (hamstring: 71% [47% - 87%] ), and Achilles tears (80-83%) had a high percentage of noncontact (NC) injury mechanisms. Direct and indirect contact-predominant injuries include medial collateral ligament (MCL) sprains (14% NC) and foot/ankle sprains (6% [4% - 10%] NC). A majority of ACL injuries (68% [61% - 75%]) occurred while defending, and quadriceps strains (81-89%) occurred while attacking.In soccer, video analysis demonstrates that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while MCL and foot/ankle injuries usually happen with direct contact. ACL injuries are more likely to be sustained when defending, specifically when pressing/tackling, and muscle injuries result from sprinting, kicking, and lunging. Most noncontact-predominant injuries occurred at a higher percentage in the first half, whereas contact-predominant injuries occurred at a higher percentage in the second half.Systematic review and meta-analysis of Level IV studies.
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