Design: Case series. Methods: 57 consecutive MCL injuries across two seasons of professional soccer matches were identified. We obtained and reviewed 37 (65% of 57 injuries) videos to establish the injury mechanism, and situational pattern and knee flexion angle. We used detailed biomechanical analysis to assess the indirect/non-contact injuries. Injury lay-off times, timing of injuries during the match and location of the injury on the pitch were also reported. Results: 23 (62%) injuries were direct contact, 9 (24%) were indirect contact and 5 (14%) were non-contact. Three main sprain mechanisms were noted: (1) direct contact/blow to the knee (n=16), (2) contact to the leg or foot (lever-like) (n=7), and (3) sliding (n=9). 73% of MCL injuries occurred during two main situations: (1) pressing/tackling (n=14, 38%), and (2) being tackled (n=13, 35%). For indirect/non-contact injuries, knee valgus loading (100% of cases), hip abduction (73% of cases) and external foot rotation (92% of cases) were prominent injury kinematics, often with lateral trunk tilt (median, 10º, 64% of cases) and rotation (65% of cases). Knee flexion angles were higher for indirect/non-contact injuries (median, 100º) than direct contact injuries (median, 22º)(P<0.01). Conclusions: Nearly two-thirds of MCL injuries occurred after direct contact; one in every 4 MCL injuries occurred after indirect contact. Three sprain mechanisms characterized MCL injuries: (1) blow to knee, (2) contact to the leg or foot (lever-like), and (3) sliding.
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