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.

Abstract

To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players. The study was preregistered on PROSPERO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Three databases were searched for Level I to 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 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 Quality Appraisal for Sports Injury Video Analysis Studies score 14.3 ± 1.9; all Level IV evidence, 1,652 videos, 17 professional males, 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 sprains (14% NC) and foot/ankle sprains (6% [4%-10%] NC). Most ACL injuries (68% [61%-75%]) occurred while defending, and quadriceps strains (81%-89%) occurred while attacking. In soccer, video analysis shows that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while medial collateral ligament 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. Level IV, systematic review and meta-analysis of Level IV studies.