AJSM - 2026-05-14 - Journal Article
Cutting Technique of Soccer Players After ACLR: On-Field Matched Control Study.
Di Paolo S, Mendicino M, Viotto M, Aparo F, Ambrosini V, Grassi A, Zaffagnini S
Topics
Key Takeaway
Pediatric soccer players cleared for return-to-sport after ACLR demonstrate persistent biomechanical risk factors during on-field cutting, including 2.3° greater knee valgus and 22.2° greater peak hip flexion during unplanned tasks compared to matched controls.
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Summary
This case-control study evaluated on-field cutting kinematics in 21 pediatric soccer players (mean age 16.7 years) post-ACLR versus 40 matched healthy controls using 8 wearable inertial sensors during planned and unplanned football-specific cutting tasks. ACLR players demonstrated significantly greater knee valgus (+2.3°), peak hip flexion (+22.2°), contralateral pelvic drop and trunk tilt (+2.9° to +3.7°), and reduced lower limb flexion ROM (-10.6° to -19.6°) despite having received RTS clearance. These alterations were most pronounced during unplanned cutting, suggesting that standard RTS criteria fail to capture sport-specific neuromuscular deficits.
Key Limitation
No prospective injury outcome tracking means the clinical significance of the observed kinematic deviations—whether they translate to actual rerupture or contralateral ACL injury—remains unestablished.
Original Abstract
BACKGROUND
Anterior cruciate ligament (ACL) ruptures in soccer most commonly occur during cutting maneuvers with noncontact injury mechanisms. Biomechanical assessment of the cutting technique has become a critical component of return-to-sport (RTS) evaluation after ACL injury, particularly in young football players at elevated risk of reinjury. However, the cutting technique in players with ACL reconstruction (ACLR) has never been examined under sport-specific conditions.
PURPOSE/HYPOTHESIS
This study aimed to evaluate the cutting technique in pediatric soccer players who had ACLR after RTS clearance against matched healthy controls during on-field soccer (or football)-specific (FS) movements. It was hypothesized that players with ACLR would exhibit risk factors for ACL injury and biomechanical differences relative to healthy counterparts.
STUDY DESIGN
Case-control study; Level of evidence, 3.
METHODS
A total of 61 young soccer players-21 with ACLR (age, 16.7 ± 1.5 years) and 40 healthy matched controls-performed planned and unplanned FS cutting tasks on a regular soccer pitch. Kinematics of the lower limbs, pelvis, and trunk were collected using 8 wearable inertial sensors. Cut-stance phase kinematics were extracted as peak values, range of motion (ROM), initial contact values, and peak knee flexion. A linear mixed-effects model tested the effects of injury (β 1 , ACLR vs healthy), limb (β 2 , injured/dominant vs noninjured/nondominant), and their interaction effect (β 2 + β 3 , injury × limb) on kinematics ( P < .05).
RESULTS
Significant injury × limb interactions ( R 2 : 0.02-0.41; P < .001- P < .046) indicated altered kinematics in players with ACLR compared with healthy controls. Players with ACLR showed greater peak hip flexion (β 1 = 22.2°), knee valgus (β 1 = 2.3°), and lower knee flexion (β 1 = -2.6°) during the unplanned FS task. Players with ACLR also showed reduced lower limb flexion ROM (β 1 = -19.6° to -10.6°) but greater pelvis and trunk flexion ROM (β 1 = 2.2° to 4.8°) during unplanned FS task and greater contralateral pelvic drop and trunk tilt (β 1 = -2.9° to -3.7°) in both tasks.
CONCLUSION
Players with ACLR showed biomechanical alterations during field-based sport-specific cutting maneuvers compared with matched healthy controls, despite RTS clearance.