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The majority of anterior cruciate ligament (ACL) injuries in team sports are non-contact injuries, with cutting maneuvers identified as high-risk tasks. Young female handball players have been shown to be at greater risk for ACL injuries than males. One risk factor for ACL injuries is the magnitude of the knee abduction moment (KAM). Cutting technique variables on foot placement, overall approach and knee kinematics have been shown to influence the KAM. Since injury risk is believed to increase with increasing task complexity, the purpose of the study was to test the effect of task complexity on technique variables that influence the KAM in female handball players during fake-and-cut tasks.
Landing heel first has been associated with elevated external knee abduction moments (KAM), thereby potentially increasing the risk of sustaining a non-contact ACL injury. Apart from the foot strike angle, knee valgus angle (VAL) and vertical center of mass velocity at initial ground contact (IC) have been associated with increased KAM in females across different sidestep cuts. While real-time biofeedback training has been proven effective for gait retraining [4], the highly dynamic, non-cyclical nature of cutting maneuvers makes real-time feedback unsuitable and alternative approaches necessary. This study aimed at assessing the efficacy of immediate software-aided feedback on cutting technique in reducing KAM during handball-specific cutting maneuvers.
The purpose of this study was to 1) compare knee joint kinematics and kinetics of fake-and-cut tasks of varying complexity in 51 female handball players and 2) present a case study of one athlete who ruptured her ACL three weeks post data collection. External knee joint moments and knee joint angles in all planes at the instance of the peak external knee abduction moment (KAM) as well as moment and angle time curves were analyzed. Peak KAMs and knee internal rotation moments were substantially higher than published values obtained during simple change-of-direction tasks and, along with flexion angles, differed significantly between the tasks. Introducing a ball reception and a static defender increased joint loads while they partially decreased again when anticipation was lacking. Our results suggest to use game-specific assessments of injury risk while complexity levels do not directly increase knee loading. Extreme values of several risk factors for a post-test injured athlete highlight the need and usefulness of appropriate screenings.