Objective This study aimed to analyse the mechanisms, injury patterns, biomechanics and neurocognitive factors of anterior cruciate ligament (ACL) tears in professional female Spanish football players during training and competitive matches. Design Systematic video-analysis observational study. Method Four hundred and sixty-one players from 16 teams of the Spanish top division (Liga F) were tracked over three consecutive seasons (2021/2022 to 2023/2024). Videos of any confirmed (via MRI) ACL tear occurring during training and matches were obtained from the teams and/or TV broadcasting. Three observers independently analysed each video reporting the mechanism, injury pattern, seasonal and match distribution, biomechanics and neurocognitive factors. Results Thirty-nine ACL tears were confirmed, and thirty ACL tears were finally included in the video analysis, with 5 occurring during training and 25 during matches. No significant differences were observed for injury mechanisms and injury patterns during training and matches. Five injuries (13%) were direct contact, 19 (49%) indirect contact and 15 (38%) non-contact. Three main injury patterns accounted for 83% of injuries: 1) pressing/tackling (42%); 2) being tackled (26%) and 3) dribbling (15%). Four specific training tasks were identified accounting for all training injuries: small-sided games (56%), ball possession games (22%), progression to target games (11%) and technical-tactical tasks (11%). Ninety-two percent of non-contact ACL tears involved motor-response or attentional inhibition errors. Conclusion Training and match ACL tears occurred under similar conditions, predominantly occurring without direct contact, particularly during pressing/tackling, being tackled and dribbling. Small-sided games may represent training activities with a higher risk of ACL tear.
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