Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Male Rugby Players: Pattern, Injury Mechanism, and Biomechanics in 57 Consecutive Cases

Background: Anterior cruciate ligament (ACL) injuries represent a significant burden to rugby players. Improving our understanding of the patterns and biomechanics that result in ACL injury may aid in the design of effective prevention programs. Purpose: To describe, using video analysis, the mechanisms, situational patterns, and biomechanics of ACL injuries in professional rugby matches. Further aims were to document injuries according to pitch location and timing within the match. Study Design: Case series; Level of evidence, 4. Methods: A total of 62 ACL injuries were identified in players of the 4 most important rugby leagues across 4 consecutive seasons. We analyzed 57 (92%) injury videos for injury mechanism and situational patterns; biomechanical analysis was performed on indirect and noncontact ACL injuries only (38 cases available). Three reviewers independently evaluated each video. Results: More injuries occurred while attacking than defending (41 [72%] vs 16 [28%]; P < .01). Regarding mechanism, 18 (32%) injuries were direct contact; 15 (26%), indirect contact; and 24 (42%), noncontact. Most direct contact injuries involved being tackled directly to the knee (n = 10). Three situational patterns were identified for players who had a noncontact or indirect contact injury: offensive change of direction (COD) (n = 18), being tackled (n = 10), and pressing/tackling (n = 8). Injuries generally involved a knee-loading strategy in the sagittal plane, which was accompanied by knee valgus loading in most cases (94%). Overall, 73% of injuries occurred during the first 40 minutes of effective playing time. Conclusion: Most ACL injuries in professional male rugby players happened through a noncontact or indirect contact mechanism (68%). Three situational patterns were described, including offensive change of direction, being tackled, and pressing/tackling. Biomechanical analysis confirmed a multiplanar mechanism, with a knee-loading pattern in the sagittal plane accompanied by dynamic valgus. As most injuries occurred in the first 40 minutes, accumulated fatigue appears not to be a major risk factor for ACL injury.