A Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Female Basketball Players

Background: Anterior cruciate ligament (ACL) injuries are common in female basketball players, who have a 2 to 3 times higher risk for an ACL injury than their male counterparts. Improving our understanding of the situations and biomechanics that result in an ACL injury in basketball players may support the design of more effective programs to mitigate the injury risk. Purpose: To describe the injury mechanisms, situational patterns, and biomechanics of ACL injuries during matches in professional female basketball players. Study Design: Case series; Level of evidence, 4. Methods: A total of 105 ACL injuries in professional female European basketball leagues from the 2018 to 2023 seasons were identified. There were 41 (39%) injury videos analyzed for injury mechanisms and situational patterns, while biomechanical analysis was possible in 33 cases. There were 3 independent reviewers who rated each video. Data according to player position, phase of the match, and location on the court were also evaluated (n = 41). Analysis regarding neurocognitive perturbation was assessed in 41 cases (100%). Results: Most injuries (n = 28 [68%]) occurred during offensive possession. Indirect contact injuries were more prevalent (n = 23 [56%]) than noncontact injuries (n = 18 [44%]). Overall, 3 main situational patterns constituted 95% of injuries: offensive cut (n = 20 [49%]), defensive cut (n = 12 [29%]), and landing from a jump (n = 7 [17%]). Injuries involving a knee-dominant pattern with valgus were identified in 64% of cases. Injuries were evenly distributed between the first (53%) and second (47%) halves of a game. Half (50%) occurred within the first 10 minutes of effective playing time, and the most frequent months of injury were October and November (44%; early season). Nearly half (46%) of the injuries occurred in small forwards, with 59% of injuries occurring in zone 5. Neurocognitive errors were seen in 56% of injuries, while 92% of defensive injuries showed signs of neurocognitive errors. Conclusion: ACL injuries in professional female basketball players were caused by indirect contact or noncontact, involving offensive and defensive cuts as well as landing from a jump. Biomechanical analysis confirmed a multiplanar mechanism with a knee-dominant pattern and valgus. Most injuries occurred early in the season and within the first 20 effective minutes played (89%), making accumulated fatigue an unlikely risk factor for ACL injuries in basketball players.