Sportverl Sportschaden 2016; 30 Das vordere Kreuzband (VKB) stabilisiert das Kniegelenk und ist wichtig für die sensomotorische Kontrolle. Bei einer isolierten Ruptur ist bei Sportlern mit einem Comeback nach sechs bis neun Monaten zu rechnen. Sind andere Strukturen mitbeschädigt, kann sich der Rehabilitationszeitraum noch weiter erhöhen. Über 70 Prozent der VKB-Verletzungen passieren ohne gegnerische Einwirkung [10]. Dass es für diese sogenannten Non-ContactVerletzungen des Kreuzbandes Risikofaktoren gibt, beschrieben Dale Daniels und sein Team bereits 1994 in einer prospektiven Studie [5]. Spätere Untersuchungen zeigten, welche dieser Faktoren beeinflussbar sind: Anatomische, hormonelle und genetische Voraussetzungen sind nicht beeinflussbare Risikofak toren für eine VKB-Ruptur [9, 2, 24]. Biomechanische und neuromuskuläre Gegebenheiten wie eine verstärkte Valgusstellung, ein asymmetrisches Landeverhalten und mangelnde Kraft und Rumpfstabilität sind hingegen beeinflussbar [14, 15, 35].

A set of exercises--the "11"--have been selected to prevent football injuries. The purpose of this cluster-randomized controlled trial was to investigate the effect of the "11" on injury risk in female youth football. Teams were randomized to an intervention (n=59 teams, 1091 players) or a control group (n=54 teams, 1001 players). The intervention group was taught the "11," exercises for core stability, lower extremity strength, neuromuscular control and agility, to be used as a 15-min warm-up program for football training over an 8-month season. A total of 396 players (20%) sustained 483 injuries. No difference was observed in the overall injury rate between the intervention (3.6 injuries/1000 h, confidence interval (CI) 3.2-4.1) and control group (3.7, CI 3.2-4.1; RR=1.0, CI 0.8-1.2; P=0.94) nor in the incidence for any type of injury. During the first 4 months of the season, the training program was used during 60% of the football training sessions, but only 14 out of 58 intervention teams completed more than 20 prevention training sessions. In conclusion, we observed no effect of the injury prevention program on the injury rate, most likely because the compliance with the program was low.

The purpose of this study was to examine the injury incidence and pattern of injuries in youth female and male team handball players using two different prospective registration methods; match reports (90 teams, 1080 players) and coach reports (34 teams, 428 players). A total of 118 injuries were recorded by the coach report, of which 93 (79%) were acute injuries (incidence training: 0.9±0.16 injuries/1000 player hours; matches: 9.9±1.26; rate ratio vs training: 10.8 [95% confidence interval (CI) 7.0–16.6]; P<0.0001) and 25 (21%) were overuse injuries. Knee (26%) and ankle (24%) injuries accounted for half of the acute injuries (training: 0.5±0.12 injuries/1000/h; matches: 4.4±0.84; rate ratio vs training: 8.0 (95% CI 4.5–14.5); P<0.0001). No gender difference was found in the injury rate (rate ratio female vs male: 1.3 (95% CI 0.8–2.1); P=0.40). Most of the injuries occurred in the attacking phase by back or wing players doing a plant‐and‐cut, landing or turning movement, and more than half in contact situations with the opponent. Similar results were observed for acute match injuries in the match report. These results indicate that the rate of injuries in youth team handball is as high as at the senior level, and prevention should focus on knee and ankle injuries. The coach report seems to be the best method to register injuries in youth team handball to provide a full spectrum of injuries according to their type, incidence and severity.

Objective To investigate the effect of a structured warm-up programme designed to reduce the incidence of knee and ankle injuries in young people participating in sports. Design Cluster randomised controlled trial with clubs as the unit of randomisation. Setting 120 team handball clubs from central and eastern Norway (61 clubs in the intervention group, 59 in the control group) followed for one league season (eight months). Participants 1837 players aged 15-17 years; 958 players (808 female and 150 male) in the intervention group; 879 players (778 female and 101 male) in the control group. Intervention A structured warm-up programme to improve running, cutting, and landing technique as well as neuromuscular control, balance, and strength. Main outcome measure The rate of acute injuries to the knee or ankle. Results During the season, 129 acute knee or ankle injuries occurred, 81 injuries in the control group (0.9 (SE 0.09) injuries per 1000 player hours; 0.3 (SE 0.17) in training v 5.3 (SE 0.06) during matches) and 48 injuries in the intervention group (0.5 (SE 0.11) injuries per 1000 player hours; 0.2 (SE 0.18) in training v 2.5 (SE 0.06) during matches). Fewer injured players were in the intervention group than in the control group (46 (4.8%) v (76 (8.6%); relative risk intervention group v control group 0.53, 95% confidence interval 0.35 to 0.81). Conclusion A structured programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programmes.

OBJECTIVE:To describe the mechanisms for anterior cruciate ligament injuries in female team handball.STUDY DESIGN:Descriptive video analysis.METHODS:Twenty videotapes of anterior cruciate ligament injuries from Norwegian or international competition were collected from 12 seasons (1988-2000). Three medical doctors and 3 national team coaches systematically analyzed these videos to describe the injury mechanisms and playing situations. In addition, 32 anterior cruciate ligament-injured players in the 3 upper divisions in Norwegian team handball were interviewed during the 1998-1999 season to compare the injury characteristics between player recall and the video analysis.RESULTS:Two main injury mechanisms for anterior cruciate ligament injuries in team handball were identified. The most common (12 of 20 injuries), a plant-and-cut movement, occurred in every case with a forceful valgus and external or internal rotation with the knee close to full extension. The other main injury mechanism (4 of 20 injuries), a 1-legged jump shot landing, occurred with a forceful valgus and external rotation with the knee close to full extension. The results from the video analysis and questionnaire data were similar.CONCLUSIONS:The injury mechanism for anterior cruciate ligament injuries in female team handball appeared to be a forceful valgus collapse with the knee close to full extension combined with external or internal rotation of the tibia.

1070 Several studies have documented a high incidence of injuries to the knee and ankle among youth players in team handball. One prevention study from Danish team handball indicates that it may be possible to reduce the incidence of these injuries, but the study power was too low. PURPOSE: To investigate the effect of a warm-up program designed to reduce the incidence of knee and ankle injuries among young players in Norwegian team handball. METHODS: Female and male players from 120 clubs at age 16–17 years in Norway were randomized to an intervention group (80 teams, 958 players) and to a control group (76 teams, 879 players), and followed for one regular season (eight months). A warm-up program with exercises to improve running and landing technique, neuromuscular control, balance, flexibility and strength was introduced by instructors from the Norwegian Handball Federation to the intervention group at the start of the season. The program included sports specific exercises with the ball, and the use of a balance mat and board. The coaches were instructed to use the program 15–20 min in 1–3 sessions per week during the season, and compliance was recorded to evaluate the team's follow-up of the program. Ten physical therapists did the injury registration in both groups, and they were blinded to group allocation. The coaches reported injuries, and practice and game exposure each month. RESULTS: During the season, there were 129 acute knee and ankle injuries, 81 injuries in the control group (0.93 ± 0.09 injuries per 1000 player hours; training: 0.3; match: 5.3) and 48 injuries in the intervention group (0.51 ± 0.11 injuries 1000 h-1; training: 0.2; match: 2.5). There were significantly fewer injured players in the intervention group (76 in control group, 8.7%; 46 in intervention group, 4.8%; relative risk vs. control group: 0.55 (0.35–0.82); p<0.005, Cox model, Walds test). CONCLUSION: The results shown that a specific handball-related warm-up program – including use of a balance mat and board – prevents knee and ankle injuries in youth team handball.

The purpose of this study was to compare the ACL injury rate between two different floor types - wooden floors (parquet, generally having lower friction) and artificial floors (generally having higher friction). ACL injuries have been recorded prospectively from the three top divisions for men and women in Norwegian team handball during seven seasons (1989-2000). A total of 174 ACL injuries have been recorded, and of these 53 occurred in regular league games. The floor types for all regular games from the same seasons have been determined retrospectively based on match schedules. The matches were divided into two groups: those played on wooden floors and those played on artificial floors. A total of nine injuries occurred among men (incidence: 0.24+/-0.09 injuries per 1000 player hours) and 44 among women (0.77+/-0.04 injuries 1000 h(-1); OR vs. men: 3.21 (1.56-6.58); P=0.001). Among men, four injuries occurred on wooden floors (0.32+/-0.13 injuries 1000 h(-1)) and five injuries occurred on artificial floors (0.20+/-0.12 injuries 1000 h(-1); OR vs. wooden floors: 0.63 (0.17-2.37); ns). Among women, eight injuries occurred on wooden floors (0.41+/-0.09 injuries 1000 h(-1); OR vs. men: 1.29 (0.39-4.28); ns) and 36 on artificial floors (0.96+/-0.04 injuries 1000 h(-1); OR vs. wooden floors: 2.35 (1.09-5.07); P=0.03; OR vs. men: 4.77 (1.87-12.18); P=0.001). These results indicate that the risk of ACL injury for women is higher on artificial floors than on wooden floors.

Objective: To assess the effect of a neuromuscular training program on the incidence of anterior cruciate ligament injuries in female team handball players. DESIGN: Prospective intervention study.Setting: Female team handball: Division I–III in Norway.Participants: Players from the top three divisions: control season (1998–1999), 60 teams (942 players); first intervention season (1999–2000), 58 teams (855 players); second intervention season (2000–2001), 52 teams (850 players).Intervention: A five‐phase program (duration, 15 min) with three different balance exercises focusing on neuromuscular control and planting/landing skills was developed and introduced to the players in the autumn of 1999 and revised before the start of the season in 2000. The teams were instructed in the program and supplied with an instructional video, poster, six balance mats, and six wobble boards. Additionally, a physical therapist was attached to each team to follow up with the intervention program during the second intervention period.Main Outcome Measures: The number of anterior cruciate ligament injuries during the three seasons and compliance with the program.Results: There were 29 anterior cruciate ligament injuries during the control season, 23 injuries during the first intervention season (OR, 0.87; CI, 0.50–1.52; P=0.62), and 17 injuries during the second intervention season (OR, 0.64; CI, 0.35–1.18; P=0.15). In the elite division, there were 13 injuries during the control season, six injuries during the first intervention season (OR, 0.51; CI, 0.19–1.35; P=0.17), and five injuries in the second intervention season (OR, 0.37; CI, 0.13–1.05; P=0.06). For the entire cohort, there was no difference in injury rates during the second intervention season between those who complied and those who did not comply (OR, 0.52; CI, 0.15–1.82; P=0.31). In the elite division, the risk of injury was reduced among those who completed the anterior cruciate ligament injury prevention program (OR, 0.06; CI, 0.01–0.54; P=0.01) compared with those who did not.Conclusions: This study shows that it is possible to prevent anterior cruciate ligament injuries with specific neuromuscular training.

PURPOSE: To assess the effect of a special balance and coordination training program on the incidence of ACL injuries in female team handball players. METHODS: The incidence of ACL injuries was evaluated in 58 female teams (9–10 players) in the three upper divisions from Aug. 15 to May 31 during the seasons 98–99 season (control period), 99–00 (intervention period I) and 00–01 (intervention period II). A program with three different balance exercises focusing on neuromuscular control and planting/landing skills was developed and introduced to the players in the autumn of 1999, and an revised program in the autumn at 2000, making the exercises more handball specific and functional. The teams were instructed to use the program three times weekly, 15 min each time, during a 5-week training period, and then once a week during the season. The teams were visited in the preparation period and were supplied with instructional video, posters, six balance mats and six wobble boards. Additionally, a physical therapist was attached to each team to follow up the intervention program from autumn 2000. RESULTS: There were 29 ACL injuries during the control season compared with 23 injuries during the intervention season I (OR: 1.15; P = 0.83), and 17 injuries during the intervention season II (OR: 1.88; P = 0.04). In the elite division there were 13 injuries during the control season and six injuries during the intervention season I (OR: 2.23; P = 0.11), and five injuries in intervention season II (OR: 2.55; P = 0.08). Of the 23 players injured during the intervention period I, five of the players had performed the program as prescribed, while seven of 17 injured players in intervention period II had followed the program as prescribed. CONCLUSION: The study shows that ACL injuries among female team handball players can be prevented with specific balance training, and it seems to be a further potential for reduction of ACL injuries through better complience with the training program.

Introduction: The aim of the study was to examine the association between floor type and the incidence of ACL injuries in Norwegian team handball. Methods: ACL injuries have been prospectively recorded during three periods: From the three upper divisions for men and women during the 1989–91 seasons, from the elite divisions for men and women during the 1993–96 seasons, and from the three upper divisions for women during the 1998–2000 seasons. A total of 174 ACL injuries have been recorded during the seven seasons studied, and of these 54 occurred in regular league matches. Injured players were interviewed based on a standard questionnaire, including information on floor type. All regular matches from the same seasons have been recorded retrospectively based on leagues schedules. A total of 6746 matches were played. The floor type was recorded for each match based on information from the Ministry of Cultural Affairs and the Norwegian Building Research Institute, and floor types were grouped in two groups: Wooden and artificial floors. Injury incidence (injuries/1000 h player hours) was compared between floor types using chi square statistics. Results: A total of 42 injuries occurred during 4440 matches on artificial floors (0.67/1000 h) and 12 injuries occurred during 2296 matches on wooden floors (0.38/1000 h; OR: 1.80 (0.91–3.61, P = 0.07). Among women 37 injuries occurred during 2682 matches on artificial floors (0.99/1000 h) and 8 injuries occurred during 1391 matches on wooden floors (0.41/1000 h; OR: 2.40 (1.07–5.59, P = 0.02). Among women in the elite division 14 injuries occurred during 633 matches on artificial floors (1.58/1000 h) and 2 injuries occurred during 289 matches on wooden floors (0.49/1000 h; OR: 3.20 (0.69–20.5, P = 0.08). Conclusion: It appears that the risk of ACL injury is higher on artificial floor types than on wooden floors.