Management of ACL Injuries in Handball

For a handball player, an anterior cruciate ligament (ACL) injury does not only represent a career-threatening injury in the short term but also a potential cause of osteoarthritis in the long term. ACL reconstruction is highly recommended in case of desire to resume handball practice. Many types of surgical techniques are currently available. Arthroscopic intra-articular ACL reconstruction with autologous tendon grafts is the first choice of treatment. In patients with big knee laxities, additional extraarticular stabilization may be required. Meniscus preservation is important for optimal knee function and for the prevention of osteoarthritis in the long term. Although most of the players will be able to return to sports (RTS) after ACL reconstruction, this cannot be guaranteed. RTS can generally be considered after a thorough rehabilitation period of 6-9 months. In young players under the age of 20, the risk of a secondary ACL injury of the contralateral knee or a recurrent graft tear in the operated knee is around 30%. For these reasons, return to sports should be preceded by functional assessments, including strength measurements and hop tests. The development of interdisciplinary strategies to bridge the frequent gap between physiotherapy and return to competition is highly recommended to allow for a safe RTS practice.