Systematic Video Analysis of ACL injuries in Male Basketball Players: Injury Mechanisms, Situational patterns, and Biomechanics Study on 36 Consecutive Cases

Background: ACL injuries represent a significant burden to basketball players. Improving our understanding of the situations and biomechanics which result in ACL injury may support the design of more effective injury risk mitigation programs. Purpose: To describe with video analysis the mechanisms, situational patterns, and gross biomechanics (kinematics) of ACL injuries in professional basketball matches. Study design: Case series. Methods: Thirty-eight ACL injuries across six consecutive seasons of professional male European basketball were identified. Thirty-six (95%) injury videos were analyzed for injury mechanism and situational pattern, whilst biomechanical analysis was possible on 32 cases. Three independent reviewers evaluated each video. ACL injury timing during the match and location on the court was also reported. Results: More injuries occurred whilst attacking (n=25, 69%), than defending (n=11, 31%). One (3%) injury was direct contact, 21 (58%) indirect contact and 14 (39%) non-contact. Most injuries (83%) occurred during three main situational patterns: 1) offensive cut (n=17, 47%); 2) landing from jump (n=8, 22%) and 3) defensive cut (n=5, 14%). Injuries generally involved a knee flexion strategy (with minimal hip/trunk flexion and reduced plantar flexion) in the sagittal plane and knee valgus loading in most cases (75%). A similar number of injuries occurred across first (53%) and second (47%) halves, with a higher prevalence in the second (37%) and fourth (34%) quarters. A third and half of injuries occurred during the first 5 and 10 minutes of effective match-time (the number of minutes the player actually played prior to the injury as opposed to the match minute), respectively. More injuries occurred in Guards (58%) and 73% of all injuries occurred in the scoring zone. Conclusion: Indirect contact as opposed to non-contact, is the main ACL injury mechanism in male professional basketball players. Three main situational patterns were described, with offensive cut being the most prevalent. Biomechanical analysis confirms a multiplanar mechanism, with knee loading patterning in the sagittal plane accompanied with dynamic valgus. More injuries occurred in the first 10 minutes of a player’s effective playing time, within the attacking zone and amongst Guards. Clinical relevance: A complete comprehension of injury causation may aid to better exercise programs design for both primary and secondary reduction of ACL injuries in male basketball.