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Author Spotlight: Integrating Mechanical and Biological Analysis in Tendinopathy Research

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Rethinking Acute Sports Injuries: Evidence for an Overuse Mechanism in Hamstring and ACL Injuries.

Bas Van Hooren¹

¹Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands.

Scandinavian Journal of Medicine & Science in Sports

|October 13, 2025

Summary

Hamstring strain and anterior cruciate ligament (ACL) injuries may stem from mechanical fatigue, not just acute events. Understanding this overuse component can improve sports injury prevention and rehabilitation strategies.

Keywords:

ACL acute damage hamstrings injury mechanical fatigue modeling overuse

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Area of Science:

Sports Medicine
Biomechanics
Orthopedics

Background:

Sports injuries are typically classified as acute or overuse.
Hamstring strain and anterior cruciate ligament (ACL) injuries are common and usually considered acute.
This review challenges the traditional view, proposing a role for mechanical fatigue.

Purpose of the Study:

To review evidence suggesting hamstring and ACL injuries can result from mechanical fatigue.
To explore the potential of mechanical fatigue as an underlying mechanism for these injuries.
To inform new approaches in sports injury prevention and management.

Main Methods:

Review of human, animal, and cadaveric studies.
Analysis of kinematic data during hamstring injury events.
Examination of ultrastructural damage in hamstring injuries.
Investigation of ACL failure under repetitive loading.
Assessment of ACL explant damage from injured patients.

Main Results:

Human studies show no kinematic deviation during hamstring injury.
Hamstring injury pathology resembles animal models of repetitive strain.
Repetitive jump landings can cause ACL failure below ultimate strength.
ACL explant damage mirrors findings from cadaveric repetitive loading studies.

Conclusions:

Mechanical fatigue may predispose hamstring and ACL tissues to failure during normal movements.
Recognizing fatigue is crucial for refining training and rehabilitation protocols.
Modeling and wearable sensors could monitor tissue load and damage to reduce injury rates.