Conclusions

This systematic review and meta-analysis shows that, across team sports, ACL injuries most often arise without a direct force application to the knee, with cutting, defensive pressing or tackling, decelerating, and landing being the dominant high-risk actions. Being tackled predominates in contact injuries. Injuries commonly occur during ball possession and offensive play, and frequently at high horizontal velocity; in football and netball, injuries occur more often early in the match. From these results, sports-specific recommendations for ACL injury prevention can be informed.

However, the interpretation is tempered by the heterogeneity in reporting (overlapping categories, limited joint distributions of mechanism by movement by velocity), scarce exposure denominators, variable study quality, and an under‑representation of female athletes. Future work should harmonize taxonomies, provide injury case-level supplemental tables enabling joint analyses, include exposure and time-of-match data, and report on sex-specific differences and recreational athletes. These improvements will help align prevention with the dominant mechanisms and their situational contexts, offering a translational route to reduce ACL injury burden across team sports.