Neuromuscular profile and eccentric deficits as multivariable predictors of anterior cruciate ligament injury risk

Introduction: Anterior cruciate ligament (ACL) injuries in soccer players are multifactorial in nature, and the evaluation of isolated predictors (such as the isokinetic hamstring-to-quadriceps [H/Q] ratio) shows limitations in identifying risk profiles. Therefore, the integration of multiple neuromuscular variables into a predictive model is proposed to overcome these inconsistencies and improve injury risk screening. Objective: To analyze the association between neuromuscular imbalances, functional asymmetries, and performance parameters in jump tests with the risk of ACL injury in soccer players, and to develop a multivariable predictive model capable of identifying clinically relevant risk profiles. Methods: A cross-sectional study with an analytical approach was conducted with 60 male soccer players aged 18–28 years. Isokinetic strength (60°/s and 180°/s), concentric and eccentric H/Q ratios, peak power, reaction time, and jump performance (CMJ, SJ, DJ, and RSI) were assessed. Inter-limb asymmetries were calculated, and their association with confirmed history of ACL injury was analyzed using Pearson correlation and multivariable logistic regression. Results: The predictive model revealed that an eccentric H/Q ratio <0.85 (OR = 5.9), DJ asymmetry >10% (OR = 4.1), CMJ power <45 W/kg (OR = 2.4), and reaction time >130 ms (OR = 1.9) significantly increased the risk of ACL injury (AUC = 0.88; accuracy = 85.3%). Conclusion: The multivariable model confirms that ACL injury risk results from the convergence of eccentric deficits, functional asymmetries, and impaired neuromuscular control. The integration of these variables is essential for accurate risk screening.