Females exhibit lower limb biomechanics associated with an increased risk of ACL injury during a handball-specific side stepping

Objectives. - To examine sex differences during a specific handball sidestepping manoeuvre especially regarding proximal and distal kinematics of the lower limb in the context of anterior cruciate ligament (ACL) injuries. Material and method. - Twenty-nine young elite handball players (15 females, 17.8 +/- 1.1 years; 14 males, 17.6 +/- 1.1 years) were recruited in this cross-sectional study. Three-dimensional kinematics data of the dominant lower limb, approach speed and foot strike pattern were recorded and compared. Results. - At initial contact, males exhibited a greater amount of pelvic pre-orientation than females (-28.3 degrees +/- 12.3 vs -17.2 degrees +/- 11.3, P = .023, d = 0.94). Women also exhibited significantly more knee extension (-24.4 degrees +/- 5.4 vs -29.7 degrees +/- 4.6, P = .012, d = 1.049) and valgus (-1.75 degrees +/- 1.8 vs 0.9 degrees +/- 2.8, P < .01, d = -1.17). During stance phase, females displayed higher peak external tibial rotation (-5.1 degrees +/- 6.2 vs -10.7 degrees +/- 6.3, P = .03, d = -0.89) whereas males showed higher peak hip abduction values (-20.8 degrees +/- 7.1 vs -14.1 degrees +/- 8.0, P = .031). Maximum knee varus was higher (7.0 degrees +/- 3.6 vs 3.3 degrees +/- 4.0, P = .028, d = -0.965) and occurred significantly earlier(16% +/- 4.0 vs 19% +/- 4.1, P = .04, d = -0.70) in males. Males showed higher approach speed(2.60 +/- 0.23 m.s(-1) vs 2.37 +/- 0.26 m.s(-1), P = .01) whereas no difference was observed in stance duration or foot strike patterns (P = .912 and P = .075 respectively). A strong correlation between maximum hip internal rotation and maximum knee valgus was found during stance phase among overall population (P < .001, adjusted R-2 = 0.66). Conclusion. - Females exhibit higher risk lower-limb postures associated with greater potential ACL injury risk during handball-specific cutting manoeuvre which should be targeted in injury mitigation programs. (C) 2021 Elsevier Masson SAS. All rights reserved.