# Anatomic Risk Factors Predisposing Female Handball Players to Non-contact Anterior Cruciate Ligament Injury

## TL;DR

Female handball players are more likely to suffer non-contact ACL injuries due to specific anatomical risk factors like knee alignment and bony structure.

## Contribution

The paper identifies and explains the interaction of anatomical factors that increase ACL injury risk in female handball players.

## Key findings

- Coronal and sagittal knee alignment abnormalities like increased Q-angle and valgus alignment contribute to ACL injury risk.
- Bony morphology in females, such as a wider pelvis and narrow intercondylar notch, increases injury susceptibility.
- Smaller ACL size and greater joint laxity in females further elevate the risk of non-contact ACL injuries.

## Abstract

Handball involves high-intensity movements that increase the risk of anterior cruciate ligament (ACL) injury, making the identification of anatomical risk factors essential. Female handball players are more vulnerable to non-contact ACL injury than male and key contributors include coronal and sagittal knee alignment abnormalities, such as increased Q-angle, valgus alignment and knee hyperextension, which predispose players to the valgus-collapse mechanism frequently observed during cutting and landing. Bony morphology in females, including wider pelvis, narrow intercondylar notch width, altered femoral anteversion and steeper posterior tibial slopes, further elevates injury risk by reducing joint constraint and increasing anterior tibial translation. Intrinsic ligament characteristics, such as smaller anterior cruciate ligament size and greater joint laxity, also heighten susceptibility in female athletes. Anterior cruciate ligament injury risk is therefore multifactorial, arising from the interaction of alignment, bony geometry and ligament properties. Understanding these factors supports targeted prevention and more effective screening in female handball athletes.