Objective To describe the mechanisms, situational patterns, and biomechanics (kinematics) of medial collateral ligament (MCL) injuries in professional male soccer players. Design Case series. Methods Fifty-seven consecutive MCL injuries across 2 seasons of professional soccer matches were identified. We obtained and reviewed 37 of 57 (65%) injury videos to establish the injury mechanism, situational pattern, and knee flexion angle. We used detailed biomechanical analysis to assess the indirect and noncontact injuries. Injury layoff times, timing of injuries during the match, and location of the injuries on the pitch were also reported. Results Twenty-three (62%) injuries were direct contact, 9 (24%) were indirect contact, and 5 (14%) were noncontact. 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). Seventy-three percent of MCL injuries occurred during 2 main situations: (1) pressing/tackling (n = 14, 38%) and (2) being tackled (n = 13, 35%). For indirect and noncontact 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, 10°; 64% of cases) and rotation (64% of cases). Knee flexion angles were higher for indirect and noncontact injuries (median, 100°) than for direct-contact injuries (median, 22°; P<.01). Conclusion Nearly two thirds of MCL injuries occurred after direct contact; 1 in every 4 MCL injuries occurred after indirect contact. Three sprain mechanisms characterized MCL injuries: (1) blow to the knee, (2) contact to the leg or foot (lever like), and (3) sliding. J Orthop Sports Phys Ther 2021;51(12):611–618. Epub 16 Nov 2021. doi:10.2519/jospt.2021.10529

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