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° ± 12.3 vs -17.2° ± 11.3, P = .023, d = 0.94). Women also exhibited significantly more knee extension (-24.4° ± 5.4 vs -29.7° ± 4.6, P = .012, d = 1.049) and valgus (-1.75° ± 1.8 vs 0.9° ± 2.8, P < .01, d = -1.17). During stance phase, females displayed higher peak external tibial rotation (-5.1° ± 6.2 vs -10.7° ± 6.3, P = .03, d = -0.89) whereas males showed higher peak hip abduction values (-20.8° ± 7.1 vs -14.1° ± 8.0, P = .031). Maximum knee varus was higher (7.0° ± 3.6 vs 3.3° ± 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 R2 = 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.
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