Epidemiology of Anterior Cruciate Ligament Injuries in the Top 5 European Football (Soccer) Leagues

The anterior cruciate ligament (ACL) is one of the most frequently injured structures in different sports, particularly football (soccer). Numerous studies have investigated the mechanisms and risk factors leading to ACL ruptures in this sport; however, most analyses have focused on individual leagues.

It was hypothesized that pooling data from different football leagues would show that (1) most ACL ruptures occur in noncontact situations, predominantly during the defensive phase and within the initial minutes of play; (2) the number and incidence rate of injuries differ significantly across leagues; and (3) the number of injuries correlates with the team market value.

Descriptive epidemiology study.

An online database was accessed to collect data on ACL ruptures and player characteristics in the top 5 European football leagues between the 2018-2019 and 2023-2024 seasons. Player age, player position, moment of injury during the season and during the match (if applicable), and team market value were initially collected. Then, the video of the moment of injury of those players injured during official matches was searched to classify the injury mechanism.

A total of 272 ACL ruptures were identified, 44.5% involving defenders. Most occurred within the first 15 minutes of play. The mean age of injured players was 25.8 ± 3.9 years. Among the 135 injuries for which video analysis was available, 84 (62.2%) occurred during defensive actions, 66 (48.9%) were classified as noncontact injuries, and 35 (33.3%) happened while pressing an opponent. Differences in the number of injuries (P = .066) and injury rate (P = .225) between leagues, as well as the correlation between team market value and number of injuries (P = .922), were not statistically significant.

Most ACL ruptures occurred through noncontact mechanisms, typically during defensive actions, particularly while pressing an opponent. Most injuries affected defenders and took place within the first minutes of play, with a mean player age of 25.8 years. No significant differences were found in the number or rate of injuries between leagues, nor was any correlation observed between team market value and the number of injuries.