{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:14:00Z","timestamp":1788369240564,"version":"build-2803163510"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Proc Inst Mech Eng H"],"abstract":"<jats:p>Anterior cruciate ligament (ACL) injuries remain a critical burden in professional football, resulting in prolonged absence and high economic costs. While physical demands have increased, traditional epidemiological surveillance relies on manual data extraction, which is resource-intensive and subjective. Large Language Models (LLMs) offer a potential solution for automated screening, but their reliability in sports medicine remains largely unexplored. This study aimed to: (1) update the epidemiology of ACL injuries in the Spanish First Division (LaLiga) over six consecutive seasons (2019\/2020\u20132024\/2025) and (2) validate the accuracy of an AI-assisted screening approach using ChatGPT compared to manual data extraction. A retrospective observational study was conducted using publicly available sources. Manual screening by external investigators (gold standard) was compared against an AI-assisted workflow based on a structured prompt-engineering framework. Analyses focused on injury frequency, mechanism, return-to-play (RTP) time, recurrence rates, and AI case-detection sensitivity. A total of 56 ACL injuries were identified in 52 players. Findings revealed a predominance in defenders (41.1%), a high prevalence of non-contact mechanisms (67.9%), and a median RTP of 280\u2009days. Notably, the match-to-training injury ratio was 1.8\u20131, a significantly narrower gap than historical records. The recurrence rate was 17.9%, with 70% of cases occurring in the contralateral knee. Methodologically, the AI model exhibited a learning curve: 44.4% sensitivity in the initial refinement season (2019\/2020), which progressed to a sustained 100% sensitivity across the following five seasons (2020\u20132025). ACL injury incidence in LaLiga remains stable, but the narrowing match-to-training ratio suggests that modern training intensities are reaching competitive levels of biomechanical stress. LLMs, once optimized through prompt engineering, provide a highly reliable and scalable tool for near real-time epidemiological surveillance, representing a methodological milestone in sports medicine research.<\/jats:p>","DOI":"10.1177\/09544119261484234","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T08:03:22Z","timestamp":1788163402000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Can LLMs reliably perform epidemiological extraction in elite football?"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1917-6171","authenticated-orcid":false,"given":"Julio","family":"L\u00f3pez-\u00c1lvarez","sequence":"first","affiliation":[{"name":"Department of Physical Education and Sport, University of Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7425-8694","authenticated-orcid":false,"given":"Adri\u00e1n","family":"Feria Madue\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sport, University of Seville, Spain"},{"name":"Asociaci\u00f3n de Investigaci\u00f3n e Innovaci\u00f3n en Ejercicio F\u00edsico y Tecnolog\u00edas Aplicadas al Movimiento y la Salud, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Ekstrand J H\u00e4gglund M Wald\u00e9n M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 2011; 45: 553\u2013558. https:\/\/doi.org\/10.1136\/bjsm.2009.060582","DOI":"10.1136\/bjsm.2009.060582"},{"key":"e_1_3_3_3_2","doi-asserted-by":"crossref","unstructured":"Rochcongar P Laboute E Jan J et al. Ruptures of the anterior cruciate ligament in soccer. Int J Sports Med 2009; 30: 372\u2013378. https:\/\/doi.org\/10.1055\/s-0028-1105947","DOI":"10.1055\/s-0028-1105947"},{"key":"e_1_3_3_4_2","doi-asserted-by":"crossref","unstructured":"Grassi A Macchiarola L Filippini M et al. Epidemiology of anterior cruciate ligament injury in Italian first division soccer players. Sports Health Multidiscip Approach 2020; 12: 279\u2013288. https:\/\/doi.org\/10.1177\/1941738119885642","DOI":"10.1177\/1941738119885642"},{"key":"e_1_3_3_5_2","doi-asserted-by":"crossref","unstructured":"Rekik RN Tabben M Eirale C et al. ACL injury incidence severity and patterns in professional male soccer players in a Middle Eastern league. BMJ Open Sport Exerc Med 2018; 4: e000461. https:\/\/doi.org\/10.1136\/bmjsem-2018-000461","DOI":"10.1136\/bmjsem-2018-000461"},{"key":"e_1_3_3_6_2","doi-asserted-by":"crossref","unstructured":"Wald\u00e9n M H\u00e4gglund M Magnusson H et al. Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc 2011; 19: 11\u201319. https:\/\/doi.org\/10.1007\/s00167-010-1170-9","DOI":"10.1007\/s00167-010-1170-9"},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","unstructured":"von Porat A Roos EM Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 2004; 63: 269\u2013273. https:\/\/doi.org\/10.1136\/ard.2003.008136","DOI":"10.1136\/ard.2003.008136"},{"key":"e_1_3_3_8_2","doi-asserted-by":"crossref","unstructured":"Zaffagnini S Grassi A Marcheggiani Muccioli GM et al. Return to sport after anterior cruciate ligament reconstruction in professional soccer players. Knee 2014; 21: 731\u2013735. https:\/\/doi.org\/10.1016\/j.knee.2014.02.005","DOI":"10.1016\/j.knee.2014.02.005"},{"key":"e_1_3_3_9_2","doi-asserted-by":"crossref","unstructured":"Pecci J S\u00e1nchez-Trigo H Mancha-Triguero D et al. Return to performance: machine learning insights into how absence time following muscle injuries affects match running performance in LaLiga soccer players. Biol Sport 2025; 42: 275\u2013286. https:\/\/doi.org\/10.5114\/biolsport.2025.151651","DOI":"10.5114\/biolsport.2025.151651"},{"key":"e_1_3_3_10_2","doi-asserted-by":"crossref","unstructured":"Reverte-Pagola G Pecci J Del Ojo-L\u00f3pez JJ et al. Analyzing the impact of non-participation in the FIFA World Cup Qatar 2022 on LaLiga players\u2019 physical performance. Front Sports Act Living 2024; 6: 1385267. https:\/\/doi.org\/10.3389\/fspor.2024.1385267","DOI":"10.3389\/fspor.2024.1385267"},{"key":"e_1_3_3_11_2","doi-asserted-by":"crossref","unstructured":"Montalvo AM Schneider DK Webster KE et al. Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by Sex and sport classification. J Athl Train 2019; 54: 472\u2013482. https:\/\/doi.org\/10.4085\/1062-6050-407-16","DOI":"10.4085\/1062-6050-407-16"},{"key":"e_1_3_3_12_2","doi-asserted-by":"crossref","unstructured":"Kaeding CC L\u00e9ger-St-Jean B Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries. Clin Sports Med 2017; 36: 1\u20138. https:\/\/doi.org\/10.1016\/j.csm.2016.08.001","DOI":"10.1016\/j.csm.2016.08.001"},{"key":"e_1_3_3_13_2","doi-asserted-by":"crossref","unstructured":"Della Villa F Buckthorpe M Grassi A et al. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med 2020; 54: 1423\u20131432. https:\/\/doi.org\/10.1136\/bjsports-2019-101247","DOI":"10.1136\/bjsports-2019-101247"},{"key":"e_1_3_3_14_2","doi-asserted-by":"crossref","unstructured":"Schiffner E Latz D Grassmann JP et al. Anterior cruciate ligament ruptures in German elite soccer players: epidemiology mechanisms and return to play. Knee 2018; 25: 219\u2013225. https:\/\/doi.org\/10.1016\/j.knee.2018.01.010","DOI":"10.1016\/j.knee.2018.01.010"},{"key":"e_1_3_3_15_2","doi-asserted-by":"crossref","unstructured":"Requejo-Herrero P Pineda-Galan C Medina-Porqueres I. Anterior cruciate ligament ruptures in Spanish soccer first division: an epidemiological retrospective study. Knee 2023; 41: 48\u201357. https:\/\/doi.org\/10.1016\/j.knee.2022.11.014","DOI":"10.1016\/j.knee.2022.11.014"},{"key":"e_1_3_3_16_2","doi-asserted-by":"crossref","unstructured":"Wald\u00e9n M H\u00e4gglund M Magnusson H et al. ACL injuries in men\u2019s 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\u2009years after ACL rupture. Br J Sports Med 2016; 50: 744\u2013750. https:\/\/doi.org\/10.1136\/bjsports-2015-095952","DOI":"10.1136\/bjsports-2015-095952"},{"key":"e_1_3_3_17_2","doi-asserted-by":"crossref","unstructured":"Leventer L Eek F Hofstetter S et al. Injury patterns among elite football players: a media-based analysis over 6 seasons with emphasis on playing position. Int J Sports Med 2016; 37: 898\u2013908. https:\/\/doi.org\/10.1055\/s-0042-108201","DOI":"10.1055\/s-0042-108201"},{"key":"e_1_3_3_18_2","doi-asserted-by":"crossref","unstructured":"Mazza D Viglietta E Monaco E et al. Impact of anterior cruciate ligament injury on european professional soccer players. Orthop J Sports Med 2022; 10: 23259671221076865. https:\/\/doi.org\/10.1177\/23259671221076865","DOI":"10.1177\/23259671221076865"},{"key":"e_1_3_3_19_2","doi-asserted-by":"crossref","unstructured":"Della Villa F Mandelbaum BR Lemak LJ. The effect of playing position on injury risk in male soccer players: systematic review of the literature and risk considerations for each playing position. Am J Orthop 2018; 47(10). https:\/\/doi.org\/10.12788\/ajo.2018.0092","DOI":"10.12788\/ajo.2018.0092"},{"key":"e_1_3_3_20_2","doi-asserted-by":"crossref","unstructured":"Lai CCH Ardern CL Feller JA et al. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates graft rupture rates and performance outcomes. Br J Sports Med 2018; 52: 128\u2013138. https:\/\/doi.org\/10.1136\/bjsports-2016-096836","DOI":"10.1136\/bjsports-2016-096836"},{"key":"e_1_3_3_21_2","doi-asserted-by":"crossref","unstructured":"Pfirrmann D Herbst M Ingelfinger P et al. Analysis of injury incidences in male professional adult and elite youth soccer players: a systematic review. J Athl Train 2016; 51: 410\u2013424. https:\/\/doi.org\/10.4085\/1062-6050-51.6.03","DOI":"10.4085\/1062-6050-51.6.03"},{"key":"e_1_3_3_22_2","doi-asserted-by":"crossref","unstructured":"Della Villa F H\u00e4gglund M Della Villa S et al. Infographic. High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study. Br J Sports Med 2021; 55: 1379\u20131380. https:\/\/doi.org\/10.1136\/bjsports-2021-104508","DOI":"10.1136\/bjsports-2021-104508"},{"key":"e_1_3_3_23_2","doi-asserted-by":"crossref","unstructured":"Niederer D Engeroff T Wilke J et al. Return to play performance and career duration after anterior cruciate ligament rupture: a case-control study in the five biggest football nations in Europe. Scand J Med Sci Sports 2018; 28: 2226\u20132233. https:\/\/doi.org\/10.1111\/sms.13245","DOI":"10.1111\/sms.13245"},{"key":"e_1_3_3_24_2","doi-asserted-by":"crossref","unstructured":"Clusmann J Kolbinger FR Muti HS et al. The future landscape of large language models in medicine. 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