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

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.