{"id":9543,"date":"2020-10-19T06:00:23","date_gmt":"2020-10-19T05:00:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=9543"},"modified":"2020-10-09T08:23:03","modified_gmt":"2020-10-09T07:23:03","slug":"football-acl-injuries-reloaded-how-where-and-when-knowledgetranslation","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2020\/10\/19\/football-acl-injuries-reloaded-how-where-and-when-knowledgetranslation\/","title":{"rendered":"Football ACL injuries reloaded: how, where, and when #KnowledgeTranslation"},"content":{"rendered":"<h5><em><strong>Part of the BJSM&#8217;s #KnowledgeTranslation blog series<\/strong><\/em><\/h5>\n<p>Anterior Cruciate Ligament (ACL) injuries are a serious concern for the football player. While there is an increasing trend for these injuries [1], the media dimension of ACL injuries is continuing to grow. 50% of these concerning injuries can be prevented [2], but conclusive data are lacking for male athletes. The first step in injury prevention is understanding how a certain injury happens, therefore the aim of our study was to describe ACL injury mechanism across 10 seasons of Serie A and Serie B.<\/p>\n<p>We studied over 134 ACL injuries, describing <strong>how, where and when<\/strong> they do happen [3]. Here are the full infographics of the paper for a quick look.<\/p>\n<p><strong><u><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-9544\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/ACL-IG.png\" alt=\"\" width=\"964\" height=\"542\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/ACL-IG.png 964w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/ACL-IG-300x169.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/ACL-IG-768x432.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/ACL-IG-640x360.png 640w\" sizes=\"auto, (max-width: 964px) 100vw, 964px\" \/><\/u><\/strong><\/p>\n<h4><strong><u>How ACL injuries happen<\/u><\/strong><\/h4>\n<p>Describing ACL injury causation was the core of our study, splitting into <strong>three main levels<\/strong>, the first level was <em>(1) injury mechanism<\/em>, we found that:<\/p>\n<ul>\n<li><strong>88%<\/strong> of injuries were indirect (IC) or non-contact (NC) (thus potentially preventable)<\/li>\n<li>IC injuries are as prevalent as NC injuries<\/li>\n<li>Only <strong>12%<\/strong> of ACL injuries involved a direct contact to the knee<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9546 alignleft\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl2.png\" alt=\"\" width=\"329\" height=\"240\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl2.png 568w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl2-300x219.png 300w\" sizes=\"auto, (max-width: 329px) 100vw, 329px\" \/><\/p>\n<ul>\n<li>In IC injuries (44%) we found a crucial role of <strong>mechanical perturbation<\/strong> (mostly, but not limited to the upper body) that triggered the ACL injury<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9547 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl3.png\" alt=\"\" width=\"598\" height=\"295\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl3.png 872w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl3-300x148.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl3-768x379.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl3-640x316.png 640w\" sizes=\"auto, (max-width: 598px) 100vw, 598px\" \/><\/p>\n<ul>\n<li>In NC injuries (44%) we found a crucial role of <strong>neurocognitive perturbation<\/strong>, a deceiving action from the opponent or a distraction (200-250 ms before the IC) that triggered high risk knee positioning.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9548 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl4.png\" alt=\"\" width=\"570\" height=\"270\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl4.png 888w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl4-300x142.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl4-768x363.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl4-640x303.png 640w\" sizes=\"auto, (max-width: 570px) 100vw, 570px\" \/><\/p>\n<p>The second level of description entails the <em>(2) situational patterns<\/em> of NC and IC ACL injuries.<\/p>\n<ul>\n<li><strong>68%<\/strong> of ACL injuries were defensive;<\/li>\n<li><strong>4 <\/strong>main situational patterns were identified;<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-9549 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl5.png\" alt=\"\" width=\"530\" height=\"382\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl5.png 680w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl5-300x216.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl5-640x461.png 640w\" sizes=\"auto, (max-width: 530px) 100vw, 530px\" \/><\/p>\n<p>Examples of defensive \u201c<strong>pressing\/tackling\u201d<\/strong> injuries:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9550 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl6.png\" alt=\"\" width=\"612\" height=\"325\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl6.png 964w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl6-300x159.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl6-768x408.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl6-640x340.png 640w\" sizes=\"auto, (max-width: 612px) 100vw, 612px\" \/><\/p>\n<p>Examples of offensive or duel \u201c<strong>tackled\u201d<\/strong> injuries:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9551 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl7.png\" alt=\"\" width=\"642\" height=\"361\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl7.png 964w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl7-300x169.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl7-768x432.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl7-640x360.png 640w\" sizes=\"auto, (max-width: 642px) 100vw, 642px\" \/><\/p>\n<p>The third and last level of the how is <em>(3) biomechanics<\/em>, with the most frequent mechanism being a <strong>dynamic knee valgus <\/strong>(81%) on an early flexed knee and hip.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-9552 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl8.png\" alt=\"\" width=\"372\" height=\"433\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl8.png 550w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl8-258x300.png 258w\" sizes=\"auto, (max-width: 372px) 100vw, 372px\" \/><\/p>\n<h4><strong><u>Where ACL injuries happen<\/u><\/strong><\/h4>\n<ul>\n<li>More injuries happen in the defensive third<\/li>\n<li>Defensive box and lateral corridors are the higher risk areas<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-9553 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl9.png\" alt=\"\" width=\"619\" height=\"457\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl9.png 726w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl9-300x221.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl9-640x473.png 640w\" sizes=\"auto, (max-width: 619px) 100vw, 619px\" \/><\/p>\n<h4><strong><u>When ACL injuries happen<\/u><\/strong><\/h4>\n<ul>\n<li>Contrary to the general belief, ACL injuries are more frequent in the first half (62%) and particularly in the <strong>first 45 minutes of gameplay (68%)<\/strong><\/li>\n<li>25% of all ACL injuries happened in the first 15 minutes of the match.<\/li>\n<li>In term of seasonal distribution, the highest peak is at the beginning (September-October)<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9545 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl10.png\" alt=\"\" width=\"660\" height=\"308\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl10.png 964w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl10-300x140.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl10-768x359.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2020\/10\/acl10-640x299.png 640w\" sizes=\"auto, (max-width: 660px) 100vw, 660px\" \/><\/p>\n<h4><strong><u>What are the take home points?<\/u><\/strong><\/h4>\n<ul>\n<li><strong>Almost 9 out of 10 football ACL injuries happen with non-contact (44%) or indirect contact (44%)<\/strong> injury mechanism and thus a part of these injuries can be prevented.<\/li>\n<li>Four main situational patterns were identified with <strong>\u201cpressing\/tackling\u201d<\/strong> (47%) and <strong>\u201ctackled\u201d<\/strong> (20%) injuries accounting for 67% of all NC or IC injuries.<\/li>\n<li>Regarding non-contact injuries, a key aspect we identified was a <strong>neurocognitive perturbation<\/strong> immediately before the initial contact to the ground, often seen in <em>pressing<\/em> situational patterns. It can be useful to train pressing technique also considering the neurocognitive aspect of the movement alongside biomechanics, including decision making. Very aggressive pressing style is a risky behavior for ACL injury.<\/li>\n<li>Regarding indirect contact injuries, the key point was a <strong>mechanical perturbation<\/strong>, generally involving the upper body, common in <em>tackling<\/em> and moreover <em>tackled<\/em> Advanced perturbation training, training for optimal stability at landing can be a useful addition to 1<sup>st<\/sup> and 2<sup>nd<\/sup> ACL injury reduction programs.<\/li>\n<li>Biomechanically <strong>dynamic knee valgus<\/strong> on a knee dominant movement pattern is the predominant mechanism of ACL injuries even in male footballers.<\/li>\n<li>Player to player engagements, especially in the defensive third and on the lateral corridors are the inciting events of many ACL injuries.<\/li>\n<li>A high proportion of ACL injuries happen in the first minutes of game play. This suggests a key role of inadequate neuromuscular readiness during intense engagements at the beginning of the match, rather than accumulated fatigue over the course of the match.<\/li>\n<\/ul>\n<p><strong>Authors and Affiliations:<\/strong><\/p>\n<p>Francesco Della Villa 1 MD, Matthew Buckthorpe 1 PhD, Alberto Grassi 2 MD, Alberto Nabiuzzi 1, Filippo Tosarelli 1, Stefano Zaffagnini MD, Stefano Della Villa 1 MD<\/p>\n<p>1 Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy<\/p>\n<p>2 IIa Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy<\/p>\n<p><strong>References:<\/strong><\/p>\n<ul>\n<li>Wald\u00e9n M, Ha\u0308gglund M, Magnusson H. ACL injuries in men&#8217;s professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. <em>Br J Sports Med<\/em> 2016;50:744-50.<\/li>\n<li>Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. <em>J Orthop Res<\/em> 2018;36:2696-2708.<\/li>\n<li>Della Villa F, Buckthorpe M, Grassi A, <em>et al<\/em>. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Published 2020 Jun 19. <em>Br J Sports Med<\/em>. 2020. doi:10.1136\/bjsports-2019-101247.<\/li>\n<\/ul>\n<p>The authors declare no competing interests in this field<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Part of the BJSM&#8217;s #KnowledgeTranslation blog series Anterior Cruciate Ligament (ACL) injuries are a serious concern for the football player. While there is an increasing trend for these injuries [1], the media dimension of ACL injuries is continuing to grow. 50% of these concerning injuries can be prevented [2], but conclusive data are lacking for [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2020\/10\/19\/football-acl-injuries-reloaded-how-where-and-when-knowledgetranslation\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":9544,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[8275,8285,16068],"class_list":["post-9543","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-acl-injuries","tag-acl-prevention","tag-featured"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Football ACL injuries reloaded: how, where, and when #KnowledgeTranslation - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2020\/10\/19\/football-acl-injuries-reloaded-how-where-and-when-knowledgetranslation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Football ACL injuries reloaded: how, where, and when #KnowledgeTranslation - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Part of the BJSM&#8217;s #KnowledgeTranslation blog series Anterior Cruciate Ligament (ACL) injuries are a serious concern for the football player. 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