Anterior Cruciate Ligament Injury: Risk Factors and Injury Mechanisms. A Systematic Review

Authors

  • Pedro Figueiredo ULS Coimbra – Physical and Rehabilitation Medicine Department, Portugal Author
  • Rodrigo Leitão Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal Author
  • João Branco Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal and ULS Coimbra – Physical and Rehabilitation Medicine Department, Portugal Author
  • João Pinheiro Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal Author

DOI:

https://doi.org/10.47363/JFMPM/2025(2)107

Keywords:

Anterior Cruciate Ligament, Risk Factors, Injury Mechanisms

Abstract

Introduction: Anterior cruciate ligament (ACL) rupture is a highly prevalent injury, particularly among athletes, and poses significant physical and psychological challenges that negatively impact quality of life. Numerous risk factors (RFs) and injury mechanisms (IMs) have been described. However, the validity of many studies in this field is questionable, underscoring the need for a critical evaluation of the existing research. This systematic review (SR) aims to assess the quality of the recent literature on ACL ruptures and identify the primary evidence based RFs and IMs.

Methods: This SR included review article published within the last five years and indexed in the PubMed database. Eligible studies focused on potential RFs and IMs associated with ACL rupture. Studies focusing on surgical or conservative treatments, concomitant injuries, or exclusively post-surgical populations were excluded. The selection process followed PRISMA guidelines, and the quality of the included articles was evaluated using the AMSTAR-2 tool.

Results: A total of 10 SRs, encompassing findings from 218 individual studies, were included. Of these, 8 reviews were rated as "critically low quality," 1 as "low quality," and 1 as "moderate quality." The analysis identified 13 potential RFs and 3 primary IMs associated with ACL rupture.

Conclusions: The overall methodological quality of the research is low, with the majority of SRs rated as "critically low." Key RFs identified include sport-specific demands, sex, neuromuscular characteristics, and a family history of ACL injury. Primary IMs associated with ACL rupture include stiff landings, heel-strike landings, knee hyperextension, valgus collapse, and internal rotation. These findings underscore the urgent need for higher-quality research to improve understanding of ACL risks and inform the development of effective prevention programs.

Author Biographies

  • Pedro Figueiredo, ULS Coimbra – Physical and Rehabilitation Medicine Department, Portugal

    Pedro Figueiredo, ULS Coimbra – Physical and Rehabilitation Medicine Department, Portugal

  • Rodrigo Leitão, Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal

    Rodrigo Leitão, Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal

  • João Branco, Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal and ULS Coimbra – Physical and Rehabilitation Medicine Department, Portugal

    João Branco, Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal and ULS Coimbra – Physical and Rehabilitation Medicine Department, Portugal

  • João Pinheiro, Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal

     João Pinheiro, Physical and Rehabilitation Faculty of Medicine, Coimbra University, Portugal

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Published

2025-04-05

Issue

Vol. 2 No. 2 (2025): Volume 2 Issue 2

Section

Articles