Mechanisms and situational patterns of anterior cruciate ligament injuries in professional women's football (soccer): A systematic video analysis across 25 leagues (2022-2024)

To identify and describe the biomechanical characteristics and football-specific contextual factors associated with anterior cruciate ligament (ACL) injuries in professional women's football. A media-based prospective cross-sectional study identified 247 ACL injuries across international matches and 25 national women's leagues (tiers 3-5) between 2022 and 2024 using a validated media-based surveillance approach. Video footage was available for 127 injuries and analysed by three reviewers using Quality Appraisal for Sports Injury Video Analysis Study (QA-SIVA) informed protocols and frame-by-frame analysis. Situational variables included player action (e.g., pressing, tackling, landing, kicking), contact mechanism, match status, positional role, playing surface, competition, pitch location and time of injury. Most injuries (67%) occurred within the first 45 min and during defensive play (65%). Mechanisms were non-contact (49%), indirect contact (41%) and direct contact (10%). Frequent scenarios included pressing/tackling (53%), being tackled (15%), regaining balance after kicking (7%) and landing from a jump (5%). Among the biomechanical subsample (57 frontal/transverse and 46 sagittal cases), commonly observed patterns during pressing or tackling included ~50° hip flexion, ~25° knee flexion, a neutral trunk position (~0°), hip abduction (66%) and knee valgus (54%). ACL injuries in professional women's football frequently occurred during defensive actions early in matches. Within the biomechanical subsample, these injuries commonly involved limited lower-limb flexion and valgus knee alignment, although findings should be interpreted cautiously due to the limited sample size. Together, these findings provide descriptive insight into common injury scenarios in professional women's football and may help inform future prevention strategies and targeted biomechanical research. N/A.