Evidence is emerging that core neurocognitive function such as working memory or inhibitory control (more response inhibition, attention) are linked to ACL injury risk. Thus far, research has been conducted in laboratory settings and the contribution of neurocognition to actual ACL injuries under real world conditions is unknown.


We hypothesized that errors in motor response inhibition and attentional inhibition contribute to non-contact ACL injuries in professional soccer players. In addition, we hypothesized high inter-rater agreement for the neurocognitive assessment based on the video analysis.


Case series


Soccer matches

Patients or Other participants

Professional male soccer players

Main Outcome Measures

Neurocognitive errors in inhibitory control were operationalized as 1) motor response inhibition was scored when a player demonstrated poor decision making and approached the opponent with high speed which reduced the ability to stop or change the intended action; 2) an attentional error was scored in case the player shifted the selective attention away from the relevant task to irrelevant stimuli. Three independent reviewers evaluated each video.


A total of 47 actual ACL injury videos were analyzed. Out of 47 non-contact ACL injuries, 26 were related to a pressing type injury and in 19 (73%) there was a deceiving action made by the opponent suggestive for poor inhibitory control of the defender. For the remaining 21 non-contact ACL injuries, 16 (76%) could be attributed to attentional errors. The agreement between the three raters was very good for all items, except for item poor decision making which showed fair to good agreement (0.71). Inter-rater reliability was excellent (ICC = 0.998–1.00).


The current student found that errors in motor response inhibitory control and attentional inhibition are common during non-contact ACL injury events in professional male soccer players. The inter-rater agreement to detect neurocognitive errors in general is very good.

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Author notes

Investigation performed at the Education and Research Department, Isokinetic Medical Group, FIFA Medical Center of Excellence, Bologna, Italy