Exposure-adjusted injury incidence and the impact of surveillance definitions in handball: a systematic review and meta-analysis of prospective cohort studies.

Handball carries a substantial injury burden, though reported incidence varies. This systematic review and meta-analysis quantified exposure-adjusted injury incidence in handball by synthesizing prospective cohort studies. Sixteen studies (11,049 players) were included. The pooled overall injury incidence was 5.05 per 1,000 hours; however, substantial heterogeneity was observed and prediction intervals were wide. Match incidence was significantly higher than training incidence, and contact injuries exceeded non-contact injuries. Notably, the difference between non-time-loss and time-loss injuries was not statistically significant (p = 0.058). Back players had significantly higher match injury rates than goalkeepers, and elite players exceeded amateurs. The knee and ankle were the most frequently injured anatomical locations, predominantly sustaining contusions and sprains. These findings emphasize the need for standardized surveillance and targeted prevention for match-related contact injuries, while highlighting that pooled rates require cautious interpretation due to extreme between-study variability.