Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors

  • Eduard Alentorn-GeliEmail author
  • Gregory D. Myer
  • Holly J. Silvers
  • Gonzalo Samitier
  • Daniel Romero
  • Cristina Lázaro-Haro
  • Ramón Cugat


Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased “core” strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation. The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players; thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury.


Prevention Non-contact ACL injury Soccer 



The authors would like to thank Professor Rodrigo C Miralles, from Universitat Rovira i Virgili and Hospital de Sant Joan, Reus, for his excellent contributions, helpful comments and interesting suggestions. We would also like to thank Dr. Gerard Moras for his advices and critical reading of the manuscript. One author (GDM) would like to acknowledge funding support from National Institutes of Health Grants R01-AR049735 and R01-AR055563.

Conflict of interest statement

No conflict of interest is declared.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Eduard Alentorn-Geli
    • 1
    • 6
    Email author
  • Gregory D. Myer
    • 2
    • 3
  • Holly J. Silvers
    • 4
  • Gonzalo Samitier
    • 1
  • Daniel Romero
    • 5
  • Cristina Lázaro-Haro
    • 1
  • Ramón Cugat
    • 1
  1. 1.Artroscopia G.C.Hospital QuirónBarcelonaSpain
  2. 2.Sports Medicine Biodynamics Center and Human Performance LaboratoryCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Rocky Mountain University of Health ProfessionsProvoUSA
  4. 4.Santa Monica Orthopaedic Sports Medicine/Research FoundationSanta MonicaUSA
  5. 5.Physical Therapy SchoolBlanquerna UniversityBarcelonaSpain
  6. 6.Dr. Ramon Cugat’s OfficeHospital QuirónBarcelonaSpain

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