Timing of ACL injuries during elite male football (soccer) matches—Impact of player position, substitutes, contact mechanisms, possession status and situational pattern: An analysis of 369 ACL injuries

Purpose: To document the timing of anterior cruciate ligament (ACL) injuries according to match minute and effective minutes played during football matches, considering player position, substitutions, contact mechanism, possession status and situational pattern. Methods: This was a subsequent analysis of previously published video analysis studies of ACL injuries in professional men's football. Only those injuries with videos in which the exact moment of the injury could be determined were included. For each video, we were concerned with the phase of the game when the ACL injury occurred (match minute) and the number of minutes played by the ACL injured player, correcting for substitutions. To allow for comparison of injury distribution across categories, frequency was reported as percentage observations in each respective time window (15 min). The relative risk (RR) of sustaining an ACL injury in the different 15‐min periods was computed. Significance testing (one‐way analysis of variance or independent t ‐test) and regression analysis were performed to determine differences in timing for the categories. Results: Injury timing data were reported for 369 ACL injuries. More injuries occurred during the first ( n = 216, 59%) than second ( n = 153, 41%) half ( p < 0.01). When considering the minutes played, 87 (24%), 167 (46%) and 246 (67%) ACL injuries occurred in the first 15, 30 and 45 min, respectively. RR for all injuries for each 15‐min period was >1 in the first 45 min of effective gameplay and <1 in the second 45 min. Substitutes had a significantly earlier ACL injury timing than starters (19.7 ± 20.1 vs. 39.7 ± 24.3 min, p < 0.001), with high RR in the first 15 min (3.21). Conclusions: More ACL injuries occur in the first 45 min of match play; among substitutes injuries occur 20 min earlier than in starters. Higher match intensity and lack of preparation (e.g., warm up) are likely explanatory. Level of Evidence Level IV.