Non-contact ACL injuries represent a major problem in team sports, especially for females and little is known about risk factors. Therefore, a five-year prospective cohort study has been initiated in the elite division of Norwegian female team handball to identify risk factors for ACL injuries. Objectives To compare previously ACL-injured and non-injured elite female team handball players, and describe side-to-side differences in ACL-injured players. Design Case-control study Participants 184 elite team handball players, 14 with unilateral reconstructed ACL injury. Methods Isokinetic quadriceps and hamstrings strength, isometric hip abduction strength, hamstrings mobility, knee laxity (KT1000), navicular drop and generalised joint laxity (Beighton index) were examined. Results No differences were found between groups in generalised joint laxity, leg press strength, navicular drop, hip anteversion or knee laxity. Injured players had greater hamstrings mobility than non-injured players (154° [149°-159°] vs. 144° [143°-146°], p=0.002) and greater hip abductor strength when the non-injured side was compared with non-injured players (13.7 [12.4-15.0] kg vs. 10.9 [10.6-11.3] kg, p<0.001). When comparing the injured and non-injured leg, injured players had lower isokinetic quadriceps (163 [146-179] vs. 181 [167-195] Nm, p=0.048) and hamstrings strength (99 [86-111] vs. 107 [97-118] Nm, p=0.042) in their injured leg and, and there was a trend towards lower hip abductor strength (12.4 [11.2-13.6] vs. 13.7 [12.4-15.0] kg, p=0.069). No difference was found in the ratio between hamstrings and quadriceps strength (0.61 [0.54-0.68] vs. 0.59 [0.55-0.64], p=0.66). Among previously injured players, there were no significant differences between legs in hamstrings mobility, knee laxity, navicular drop or isometric hip abductor strength. Conclusions Generally, ACL-injured players were at least as strong as the non-injured group, but have returned to elite level pivoting sport with strength differences between the injured and the non-injured leg. Such side differences may leave the players prone to new injuries
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