{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:29:06Z","timestamp":1791973746665,"version":"4.4.0"},"reference-count":50,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis aimed to investigate anterior cruciate ligament (ACL) injury mechanisms across sports by quantifying the prevalence of direct\u2010contact, indirect\u2010contact and non\u2010contact injuries and identifying the sport\u2010specific activities most commonly associated with these mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines, MEDLINE, Embase and the Cochrane Library were searched from January 2000 through August 2025. Eligible studies included skeletally mature athletes with primary ACL injuries in whom injury mechanisms were assessed through video analysis. Overall, 1333 athletes were included (79.4% male, 19.1% female; sex not reported in 1.5%), with a weighted mean age of 25.3\u2009\u00b1\u20094.6 years. Contact mechanisms were classified as direct contact (force applied directly to the knee), indirect contact (external force applied to another body region leading to knee loading) or non\u2010contact (no external force). Activity was defined as the sport\u2010specific task at the time of injury; quantitative hip, knee or ankle kinematics were not assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010six studies were included. Overall, 45.1% of ACL injuries were non\u2010contact, 41.0% indirect\u2010contact and 18.5% direct\u2010contact. Basketball players had a higher risk of indirect\u2010contact injuries (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.21\u20131.49), whereas rugby and American football players showed greater odds of direct\u2010contact injuries (OR, 1.16; 95% CI, 1.04\u20131.31). Non\u2010contact injuries were most frequent in handball, netball and skiing (OR, 1.29; 95% CI, 1.11\u20131.49). Activity analysis showed that ACL injuries most commonly occurred during jump landings and speed\u2010related movements, with basketball players at increased risk during jump take\u2010off and change\u2010of\u2010direction tasks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ACL injury mechanisms differed substantially across sports. Basketball was predominantly associated with indirect\u2010contact injuries, rugby and football with direct\u2010contact mechanisms, and handball, netball and skiing with non\u2010contact injuries. Prevention programmes should integrate universal neuromuscular training with sport\u2010specific components targeting the dominant injury mechanisms of each discipline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, systematic review and meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70408","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:01:57Z","timestamp":1776171717000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mechanisms of anterior cruciate ligament injury across sports: A systematic review and meta\u2010analysis of video\u2010based studies"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1216-792X","authenticated-orcid":false,"given":"Riccardo","family":"D'Ambrosi","sequence":"first","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant'Ambrogio Milan Italy"},{"name":"Dipartimento di Scienze Biomediche per la Salute Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Carrozzo","sequence":"additional","affiliation":[{"name":"Link Campus University Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Monaco","sequence":"additional","affiliation":[{"name":"Sant'Andrea University Hospital, La Sapienza University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Baumert","sequence":"additional","affiliation":[{"name":"Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism Private University for Health Sciences Hall in Tirol Austria"},{"name":"School of Sport and Exercise Sciences Liverpool John Moores University Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Ursino","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant'Ambrogio Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivas B. S.","family":"Kambhampati","sequence":"additional","affiliation":[{"name":"Sri Dhaatri Orthopaedic, Maternity and Gynaecology Center SKDGOC Vijayawada Andhra Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca Maria","family":"Sconfienza","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014Sant'Ambrogio Milan Italy"},{"name":"Dipartimento di Scienze Biomediche per la Salute Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Herbst","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery University of Muenster Muenster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Abermann","sequence":"additional","affiliation":[{"name":"Gelenkpunkt\u2010Sports and Joint Surgery FIFA Medical Centre of Excellence Innsbruck 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