Rapid Posterior Tibial Reduction After Noncontact Anterior Cruciate Ligament Rupture: Mechanism Description From a Video Analysis

Background: The mechanisms of noncontact anterior cruciate ligament (ACL) injuries are an enormously debated topic in sports medicine; however, the late phases of injury have not yet been investigated. Hypothesis: A well-defined posterior tibial translation can be visualized with its timing and patterns of knee flexion after ACL injury. Study Design: Case series. Level of Evidence: Level 4. Methods: A total of 137 videos of ACL injuries in professional male football (soccer) players were screened for a sudden posterior tibial reduction (PTR) in the late phase of noncontact ACL injury mechanism. The suitable videos were analyzed using Kinovea software for sport video analysis. The time of initial contact of the foot with the ground, the foot lift, the start of tibial reduction, and the end of tibial reduction were assessed. Results: A total of 21 videos exhibited a clear posterior tibial reduction of 42 ± 11 ms, after an average of 229 ± 81 ms after initial contact. The tibial reduction occurred consistently within the first 50 to 60 ms after foot lift (55 ± 30 ms) and with the knee flexed between 45° and 90° (62%) or more than 90° (24%). Conclusion: A rapid posterior tibial reduction is consistently present in the late phases of noncontact ACL injuries in some male soccer players, with a consistent temporal relationship between foot lift from the ground and consistent degrees of knee flexion near or above 90°. Clinical Relevance: This study provides insight into the late phases of ACL injury. The described mechanism, although purely theoretical, could be responsible for commonly observed intra-articular lesions.