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No association between static and dynamic postural control and ACL injury risk among female elite handball and football players: a prospective study of 838 players
  1. Kathrin Steffen1,
  2. Agnethe Nilstad1,
  3. Tron Krosshaug1,
  4. Kati Pasanen2,
  5. Aleksander Killingmo1,
  6. Roald Bahr1
  1. 1Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  2. 2Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
  1. Correspondence to Dr Kathrin Steffen, Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, PB 4014 Ullevaal Stadion, Oslo N-0806, Norway; kathrin.steffen{at}


Background Research on balance measures as potential risk factors for ACL injury is limited.

Objective To assess whether postural control was associated with an increased risk for ACL injuries in female elite handball and football players.

Method Premier league players were tested in the preseason and followed prospectively for ACL injury risk from 2007 through 2015. At baseline, we recorded player demographics, playing experience, ACL and ankle injury history. We measured centre of pressure velocity in single-leg stabilisation tests and reach distances in the Star Excursion Balance Test. To examine the stability of postural control measures over time, we examined their short-term and long-term reproducibility. We generated logistic regression models, 1 for each of the proposed risk factors.

Results A total of 55 (6.6%) out of 838 players (age 21±4 years; height 170±6 cm; body mass 66±8 kg) sustained a non-contact ACL injury after baseline testing (1.8±1.8 years). When comparing normalised balance measures between injured and uninjured players in univariate analyses, none of the variables were statistically associated with ACL injury risk. Short-term and long-term reproducibility of the selected variables was poor. Players with a previous ACL injury had a 3-fold higher risk of sustaining a new ACL injury compared with previously uninjured players (OR 2.9, CI 1.4 to 5.7).

Conclusions None of postural control measures examined were associated with increased ACL injury risk among female elite handball and football players. Hence, as measured in the current investigation, the variables included cannot be used to predict ACL injury risk.

  • ACL
  • Injury prevention
  • Handball
  • Football
  • Risk factor
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  • Contributors KS, AN, TK, KP, AK and RB contributed to the study design and data recoding preparation. All authors were responsible for the data collection and analysis, and KS wrote the first draft. All authors contributed to the final paper. KS, TK and RB are responsible for the overall content as guarantors.

  • Competing interests None declared.

  • Ethics approval The Regional Committee for Medical Research Ethics, South-Eastern Norway Regional Health Authority and the Norwegian Social Science Data Services approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement In addition to this paper, two other papers reporting different outcome measures have been published so far.27 ,41

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