Foot and Ankle Contributions to Noncontact ACL Injury Risk: A Systematic Review

Area of Science:

• Sports Medicine
• Biomechanics
• Orthopedics

Background:

• Noncontact anterior cruciate ligament (ACL) injuries are prevalent in athletes, often leading to long-term consequences.
• Altered foot and ankle biomechanics, landing strategies, and previous ankle injuries are suspected contributors to ACL injury risk.

Purpose of the Study:

• To identify key biomechanical risk factors of the foot and ankle associated with anterior cruciate ligament (ACL) injury risk.

Main Methods:

• A systematic review adhering to PRISMA 2020 guidelines was conducted, searching PubMed, Cochrane, and SPORTDiscus databases.
• Studies published between 2010-2025 evaluating ACL injuries and foot/ankle parameters were screened and reviewed.
• Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS).

Main Results:

• Of 1772 studies, 48 met inclusion criteria; 68.8% identified increased ACL injury risk factors.
• Common risk factors included greater dynamic rearfoot motion, increased dorsiflexion, medial arch collapse, rearfoot/flatfoot strikes, and altered toe positions.
• Female athletes exhibited more high-risk biomechanical patterns; basketball, soccer, and handball were the most studied sports.

Conclusions:

• Foot and ankle factors like prior injury, alignment, and foot strike patterns significantly influence ACL injury risk, though their precise role in knee stabilization requires further investigation.
• The foot and ankle are understudied concerning their role in dynamic tasks affecting knee stability.
• High-quality, comparative research addressing sex and sport differences is crucial for targeted prevention and improved risk stratification.