Skip to main content

Rehabilitation of ACL Injury in the Handball Player

  • Chapter
  • First Online:
Book cover Handball Sports Medicine

Abstract

Handball players with ACL injury (whether treated surgically or non-surgically) must complete a high-quality, supervised, criterion-based rehabilitation programme with high adherence. The overarching goal of rehabilitation after ACL injury and/or surgery is to restore knee function so that the player can participate fully in all aspects of life, with an acceptable risk for reinjury and post-traumatic osteoarthritis. Rehabilitation for the handball player with ACL injury should commence as soon as possible following the injury to ensure optimal loading and facilitate tissue healing, to build the player’s confidence and motivation and to provide the best opportunity for the player to reach his or her sports participation goals. Individualised rehabilitation that emphasises the physical performance characteristics needed for successful handball performance must incorporate criterion-based progressions that also respect the time required for biological healing. Quality rehabilitation should address five key phases, with each phase building on the functional gains made in the previous phase: prehabilitation (for players having ACL reconstruction), acute phase (impairment focus), intermediate phase (dynamic knee stability focus), late phase (sport-specific focus) and injury prevention phase (manage workload focus). Managing effusion and pain throughout rehabilitation provides a helpful guide for optimal loading of the knee. It is also important to consider the overall acute and chronic workload of the player, especially before returning to training and competition. Psychological factors including motivation, reinjury anxiety and confidence may be addressed during rehabilitation using goal setting and consistent assessment and feedback.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 229.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Frobell R, Lohmander LS, Roos H. Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings. Scand J Med Sci Sports. 2007;17:109–14.

    CAS  PubMed  Google Scholar 

  2. Nordenvall R, Bahmanyar S, Adami J, Stenros C, Wredmark T, et al. A population-based nationwide study of cruciate ligament injury in Sweden, 2001-2009: incidence, treatment, and sex differences. Am J Sports Med. 2012;40:1808–13.

    Article  Google Scholar 

  3. Waldén M, Hägglund M, Werner J, Ekstrand J. The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective. Knee Surg Sports Traumatol Arthrosc. 2011;19:3–10.

    Article  Google Scholar 

  4. Kvist J, Kartus J, Karlsson J, Forssblad M. Results from the Swedish national anterior cruciate ligament register. Arthroscopy. 2014;30:803–10.

    Article  Google Scholar 

  5. Bere T, Alonso JM, Wangensteen A, Bakken A, Eirale C, et al. Injury and illness surveillance during the 24th Men's handball world championship 2015 in Qatar. Br J Sports Med. 2015;49:1151–6.

    Article  Google Scholar 

  6. Giroto N, Hespanhol Junior LC, Gomes MR, Lopes AD. Incidence and risk factors of injuries in Brazilian elite handball players: a prospective cohort study. Scand J Med Sci Sports. 2017;27:195–202.

    Article  CAS  Google Scholar 

  7. Langevoort G, Myklebust G, Dvorak J, Junge A. Handball injuries during major international tournaments. Scand J Med Sci Sports. 2007;17:400–7.

    CAS  Google Scholar 

  8. Møller M, Attermann J, Myklebust G, Wedderkopp N. Injury risk in Danish youth and senior elite handball using a new SMS text messages approach. Br J Sports Med. 2012;46(7):531.

    Article  Google Scholar 

  9. Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury pattern in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports. 2006;16:426–32.

    Article  Google Scholar 

  10. Olsen OE, Myklebust G, Engebretsen L, Holme I, Bahr R. Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ. 2005;330:449.

    Article  Google Scholar 

  11. Petersen W, Braun C, Bock W, Schmidt K, Weimann A, et al. A controlled prospective case control study of a prevention training program in female team handball players: the German experience. Arch Orthop Trauma Surg. 2005;125:614–21.

    Article  Google Scholar 

  12. Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Injuries in young female players in European team handball. Scand J Med Sci Sports. 1997;7:342–7.

    Article  CAS  Google Scholar 

  13. Myklebust G, Skjølberg C, Bahr R. ACL injury incidence in female handball 10 years after the Norwegian ACL prevention study: important lessons learned. Br J Sports Med. 2013;47:476–9.

    Article  Google Scholar 

  14. Waldén M, Hägglund M, Magnusson H, Ekstrand J. Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc. 2011;19:11–9.

    Article  Google Scholar 

  15. Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. 2004;32:1002–12.

    Article  Google Scholar 

  16. Myklebust G, Engebretsen L, Braekken IH, Skjølberg A, Olsen OE, et al. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. 2003;13:71–8.

    Article  Google Scholar 

  17. Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, et al. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2015;49:385–9.

    Article  CAS  Google Scholar 

  18. Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L. Sport-specific injury pattern recorded during anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41:2814–8.

    Article  Google Scholar 

  19. Shelbourne KD, Benner RW, Gray T. Results of anterior cruciate ligament reconstruction with patellar tendon autografts: objective factors associated with the development of osteoarthritis at 20 to 33 years after surgery. Am J Sports Med. 2017;45(12):2730–8. https://doi.org/10.1177/0363546517718827.

    Article  PubMed  Google Scholar 

  20. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50:804–8.

    Article  Google Scholar 

  21. Øiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23:171–7.

    Article  Google Scholar 

  22. Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38:1968–78.

    Article  Google Scholar 

  23. Di Stasi SL, Logerstedt D, Gardinier ES, Snyder-Mackler L. Gait patterns differ between ACL-reconstructed athletes who pass return-to-sport criteria and those who fail. Am J Sports Med. 2013;41:1310–8.

    Article  Google Scholar 

  24. Wellsandt E, Gardinier ES, Manal K, Axe MJ, Buchanan TS, et al. Decreased knee joint loading associated with early knee osteoarthritis after anterior cruciate ligament injury. Am J Sports Med. 2016;44:143–51.

    Article  Google Scholar 

  25. Ardern CL, Kvist J, Webster KE. Psychological aspects of anterior cruciate ligament injuries. Oper Tech Sports Med. 2015;24:77–83.

    Article  Google Scholar 

  26. Blanchard S, Glasgow P. A theoretical model to describe progressions and regressions for exercise rehabilitation. Phys Ther Sport. 2014;15:131–5.

    Article  Google Scholar 

  27. Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med. 2017;47:221–32.

    Article  Google Scholar 

  28. Claes S, Verdonk P, Forsyth R, Bellemans J. The "ligamentization" process in anterior cruciate ligament reconstruction: what happens to the human graft? A systematic review of the literature. Am J Sports Med. 2011;39:2476–83.

    Article  Google Scholar 

  29. Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, et al. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44:1861–76.

    Article  Google Scholar 

  30. Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50:946–51.

    Article  Google Scholar 

  31. van Melick N, van Cingel REH, Brooijmans F, Neeter C, van Tienen T, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50:1506–15.

    Article  Google Scholar 

  32. Bieler T, Sobol NA, Andersen LL, Kiel P, Løfholm P, et al. The effects of high-intensity versus low-intensity resistance training on leg extensor power and recovery of knee function after ACL-reconstruction. Biomed Res Int. 2014;2014:278512.

    Article  Google Scholar 

  33. Williams GN, Chmielewski T, Rudolph K, Buchanan TS, Snyder-Mackler L. Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther. 2001;31:546–66.

    Article  CAS  Google Scholar 

  34. Toohey LA, Drew MK, Cook JL, Finch CF, Gaida JE. Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis. Br J Sports Med. 2017;51(23):1670–8. https://doi.org/10.1136/bjsports-2017-097500.

    Article  PubMed  Google Scholar 

  35. Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50:853–64.

    Article  Google Scholar 

  36. Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008;9:9–15.

    Article  Google Scholar 

  37. Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48:1543–52.

    Article  Google Scholar 

  38. Lai CC, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med. 2018;52(2):128–38. https://doi.org/10.1136/bjsports-2016-096836.

    Article  PubMed  Google Scholar 

  39. Frobell R, Roos E, Roos H, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363:331–42.

    Article  CAS  Google Scholar 

  40. Frobell R, Roos H, Roos E, Roemer FW, Ranstam J, et al. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232.

    Article  Google Scholar 

  41. Myklebust G, Holm I, Mæhlum S, Engebretsen L, Bahr R. Clinical functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury. A follow-up study. Am J Sports Med. 2003;31:981–9.

    Article  Google Scholar 

  42. Grindem H, Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A pair-matched comparison of return to pivoting sports at 1 year in anterior cruciate ligament-injured patients after a nonoperative versus an operative treatment course. Am J Sports Med. 2012;40:2509–16.

    Article  Google Scholar 

  43. Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, et al. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014;48:1613–9.

    Article  Google Scholar 

  44. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596–606.

    Article  Google Scholar 

  45. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013;41:1549–58.

    Article  Google Scholar 

  46. Waldén M, Hägglund M, Ekstrand J. High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury. Br J Sports Med. 2006;40:158–62.

    Article  Google Scholar 

  47. Blanch P, Gabbett TJ. Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player’s risk of subsequent injury. Br J Sports Med. 2016;50:471–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Clare Ardern .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 ESSKA

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ardern, C., Grindem, H., Kvist, J., Waldén, M., Hägglund, M. (2018). Rehabilitation of ACL Injury in the Handball Player. In: Laver, L., Landreau, P., Seil, R., Popovic, N. (eds) Handball Sports Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55892-8_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-55892-8_33

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-55891-1

  • Online ISBN: 978-3-662-55892-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics