A Retrospective Systematic Video Analysis of Reported ACL Injury Events in Professional Male Football Across European Competitions

Anterior cruciate ligament (ACL) injuries severely impact football players and their teams, highlighting the need for a precise understanding of mechanisms to optimize prevention. This study evaluated, through video analysis, the mechanisms, situational patterns, match distribution, and neurocognitive errors of 119 match-related ACL injuries in professional football players in six European professional leagues over four seasons (2020–2024). Overall, most injuries occurred during defensive actions (59%). Furthermore, 75% of cases (n = 89) occurred without direct knee contact, comprising indirect-contact (40%) and non-contact (35%) mechanisms. Within this subgroup, pressing (26%), tackling (17%), and being tackled (9%) emerged as the main situational patterns. Although non-significant, regarding chronological match time, 57% of cases occurred in the first half and 33% within the initial 25 min. When evaluating individual playing time, a higher proportion of injuries occurred during the player’s initial 45 min on the pitch (66%). Neurocognitive errors were identified in 45/89 (51%) of non-contact and indirect-contact cases, specifically involving motor response (27/89, 30%; 95% CI: [21.8–40.5%]) and attentional inhibition (25/89, 28%; 95% CI: [19.8–38.2%]). In conclusion, ACL injuries in elite male European football were frequently associated with unexpected mechanical perturbations combined with situations suggesting high neurocognitive demands.