Landing-Related Mechanisms Predominate in Anterior Cruciate Ligament Injuries Among Young Athletes Regardless of Contact

ContextACL injury prevention in young athletes has traditionally relied on a dichotomous classification of contact versus noncontact mechanisms; however, this framework may not adequately capture the movement processes underlying many injuries. ObjectiveTo classify ACL injury mechanisms in athletes aged [&le;]22 years with a specific focus on landing-related movements and to examine their associations with sport contact characteristics and age. DesignRetrospective observational study. SettingSingle sports injury clinic. Patients or Other ParticipantsA total of 151 athletes aged [&le;]22 years (mean age, 17.7 {+/-} 2.1 years) diagnosed with ACL injury between January 2017 and November 2025. Main Outcome Measure(s)ACL injury mechanisms were classified as landing-related without contact (L), landing-related with contact (Lc), or direct contact injury (C). Landing-related injuries (L + Lc) were compared with direct contact injuries. Multivariable logistic regression was used to identify factors associated with landing-related injury. ResultsLanding-related injuries accounted for 123 cases (81.5%), including 88 noncontact and 35 contact-related landing injuries, whereas direct contact injuries occurred in 24 cases (15.9%). Athletes with direct contact injuries were significantly older than those with landing-related injuries (19.2 {+/-} 1.7 vs 17.5 {+/-} 2.5 years, p = 0.03). In multivariable analysis, participation in noncollision sports was strongly associated with landing-related injury (odds ratio [OR] = 9.80; 95% confidence interval [CI] = 3.03-31.5; p < 0.001), whereas increasing age was inversely associated with landing-related injury (OR per year = 0.71; 95% CI = 0.56-0.90). Sex was not independently associated with injury mechanism. ConclusionsMost ACL injuries in athletes aged [&le;]22 years occurred through landing-related mechanisms, regardless of contact. These findings highlight insufficient control of landing and foot contact as a fundamental mechanism of ACL injury in young athletes and support prevention strategies focused on movement quality during sport-specific tasks. Key Points{blacksquare} Most ACL injuries in athletes aged [&le;]22 years occurred during landing or foot contact, regardless of whether external contact was present. {blacksquare}Noncollision sports and younger age were strongly associated with landing-related ACL injury mechanisms. {blacksquare}ACL injury prevention in young athletes should prioritize improving landing and foot contact control rather than focusing solely on contact characteristics.