Anterior Cruciate Ligament - The evidence around mechanism of injury

Updated: Mar 4, 2020


If you are a Sports Therapist working with a Sports Team there is no doubt that you will regularly hear the term "ACL", with players often understanding the consequences of injury to that specific anatomy of the knee.

With it being such a common injury in sport, it is important to first of all discuss the mechanism of injury prior to diving into the potential interventions that we can make as Sports Therapists to try to prevent it occurring, or in the case of ACL injury, attempting to return the athlete back to training.

If this is an area that has intrigued you, as it has done me, then read on...I guarantee that you will come out the other end more informed!

Interestingly, approximately 75% of ACL injuries occur from non-contact injury (Wetters, 2015; Wetter et al., 2015). A statistic that does make you consider whether there is a specific role that we can play to try to decrease the incidence occurring within sport. Furthermore, personal experience from working within soccer, the statistics may indicate that a team could expect to have a player suffer from an ACL injury every second season.

Approximately 75% of ACL injuries occur from non-contact injury

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Importantly, non-contact injury has been characterised as a player landing with a planted foot with internal/ external rotation at the knee which creates a tibial torsion thus disrupting the ACL, with various tasks being associated with this mechanism including landing, push-off with a change of direction and fast paced cutting (Kobayashi et al., 2010; Joseph et al., 2013; Voskanian et al., 2013). In addition, in some non-contact rupture cases, rapid deceleration moments and deceleration with change of direction have also been speculated to be a cause (Voskanian et al., 2013; Wetters et al., 2015). Knee valgus collapse within the frontal plane during loading upon landing has repeatedly been associated with ACL injury (Quatman, 2009; McLean et al., 2005; Cochrane et al., 2007).


Gender specific differences have been linked to ACL injury including anatomical variations such as pelvic width and Q angle, both of which have been identified as being larger in the female athlete. As a result of the anatomical difference, there may be associated muscular weakness, increased moments at the knee and additional changes in biomechanics leading to an increased risk (McLean et al., 2005; Mountcastle et al., 2007; Price et al., 2016). Another contributing factor in which little research has been completed is the menstrual cycle of the female athlete. It is theorised that female hormone fluctuations (particularly in the luteal phase) could influence ligament laxity (Hewett et al., 2006; Zazulak et al., 2006; Belanger et al., 2013).

There certainly is more research needed to explore the gender differences in ACL injury risk and whether injury prevention strategies are effective!

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