{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:05:39Z","timestamp":1789589139441,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Anterior cruciate ligament (ACL) injuries are among the most severe knee injuries in handball, often resulting in surgical reconstruction and prolonged rehabilitation. Research on specific ACL injury mechanisms remains limited, though essential for prevention. The aim of this study was to investigate ACL injury mechanism in handball players.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A registry\u2010based study identified patients in the Danish National Patient Register with International Classification of Diseases (ICD)\u00a0codes S835 (cruciate ligament lesion) and M235 (chronic knee instability) between 2000 and 2018. Players completed a questionnaire on ACL injury mechanism, and only handball\u2010related cases were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 90,608 registry\u2010identified patients invited to participate, 40,691 responded (45%); 26,627 reported an ACL injury, of whom 4540 reported sustaining the injury while playing handball. Most injuries were non\u2010contact (55%), frequently occurring during pivoting actions (25%) and single\u2010leg landings (11%). Female players reported significantly more non\u2010contact injuries (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). Indirect contact not involving the injured knee accounted for 31% of injuries. Players were in ball possession in 80% of cases, mainly while feinting (32%) or shooting (30%). Most ACL injuries (86.1%) occurred on the opponent's half of the court during offensive play, particularly between the opponent's goal\u2010area and free\u2010throw lines (38.1%). Back\u2010line players accounted for 61% of ACL injuries. Male players reported more injuries during counterattacks (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Players aged 40 years or older had more injuries as goalkeepers compared with other positions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Non\u2010contact movements were the most common ACL injury mechanism in handball, followed by indirect contact not involving the injured knee. Injuries predominantly occurred during ball possession, particularly while feinting or shooting. Most injuries occurred during offence and among back\u2010line players.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70595","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:31:23Z","timestamp":1789587083000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["ACL injury mechanism in elite and recreational handball players"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3998-7370","authenticated-orcid":false,"given":"Thomas Wagenblast","family":"Mayntzhusen","sequence":"first","affiliation":[{"name":"Sports Orthopedic Research Center\u2014Copenhagen (SORC\u2010C), Department of Orthopedic Surgery Copenhagen University Hospital Amager\u2010Hvidovre Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2620-5891","authenticated-orcid":false,"given":"Kristoffer Weisskirchner","family":"Barfod","sequence":"additional","affiliation":[{"name":"Sports Orthopedic Research Center\u2014Copenhagen (SORC\u2010C), Department of Orthopedic Surgery Copenhagen University Hospital Amager\u2010Hvidovre Denmark"},{"name":"Section for Sports Traumatology, Department of Orthopedic Surgery Copenhagen University Hospital\u2014Bispebjerg and Frederiksberg Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik Flensted","family":"Andersen","sequence":"additional","affiliation":[{"name":"Sports Orthopedic Research Center\u2014Copenhagen (SORC\u2010C), Department of Orthopedic Surgery Copenhagen University Hospital Amager\u2010Hvidovre Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2098-0272","authenticated-orcid":false,"given":"Per","family":"H\u00f6lmich","sequence":"additional","affiliation":[{"name":"Sports Orthopedic Research Center\u2014Copenhagen (SORC\u2010C), Department of Orthopedic Surgery Copenhagen University Hospital Amager\u2010Hvidovre Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9754-7480","authenticated-orcid":false,"given":"Niels Christian","family":"Kaldau","sequence":"additional","affiliation":[{"name":"Sports Orthopedic Research Center\u2014Copenhagen (SORC\u2010C), Department of Orthopedic Surgery Copenhagen University Hospital Amager\u2010Hvidovre Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-017-4758-5"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-009-0813-1"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13090"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2010.076364"},{"issue":"6","key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1177\/036354659502300611","article-title":"Knee injury patterns among men and women in collegiate basketball and soccer","volume":"23","author":"Arendt E","year":"1995","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2005.018341"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2199-8"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelekin.2010.10.008"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094972"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.25257"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-092380"},{"issue":"3","key":"e_1_2_13_13_1","article-title":"Validity of sports\u2010related diagnosis codes in the Danish National Patient Register","volume":"68","author":"Gadeberg MN","year":"2021","journal-title":"Dan. 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