ACL injury characteristics in badminton : A registry study with prospectively collected data on sports related epidemiology and injury mechanism of 539 badminton players

Introduction to the Article

The registry study by Kaldau et al. (2024), published in the Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, investigates the characteristics and mechanisms of anterior cruciate ligament (ACL) injuries in badminton. Despite growing concern regarding ACL injuries in elite badminton players, limited scientific evidence has been available on injury patterns specific to this sport. This study aimed to determine whether ACL injuries occur in specific court positions and/or during certain movements. Secondary objectives included comparisons across gender, age groups, and levels of play (recreational vs. tournament players).

The hypothesis was that most ACL injuries occur with single-leg landings on the non-dominant leg in the backhand side or with lunge movements on the forehand side using the dominant leg. The authors aimed to support injury prevention strategies by clarifying movement patterns, court zones, and demographic differences associated with ACL injury risk.

Summary of Key Aspects

Study Design and Participant Profile

This registry-based study analyzed data from the Danish National Patient Register (DNPR), focusing on individuals diagnosed with ACL rupture between 2000 and 2018. In total, 539 participants reported having sustained their injury while playing badminton and completed a detailed follow-up questionnaire distributed in late 2021.

Among the participants, 52% were female and 48% male, with an average age of 36.7 years at the time of injury. A large majority (81%) identified badminton as their primary sport in the six months prior to the injury. In terms of playing level, 29% of respondents competed at a tournament level (Tegner score ≥8), while 66% were recreational players.

Court Zones and Injury Location

The most frequent injury location was the rear court, accounting for 45% of all reported cases. Injuries in the mid and front courts each represented 22%, with a noticeable tendency for injuries on the forehand side—especially at the net and midcourt.

Age played a role: players aged 18 to 29 were more likely to sustain injuries in the rear court (p < 0.001). Regarding laterality, injuries to the dominant leg occurred more often on the forehand side, while injuries to the non-dominant leg were concentrated in the backhand rear corner. Among competitive players, this backhand rear court area was significantly more injury-prone (p = 0.011).

Movement Patterns Leading to Injury

Players described a variety of movements that immediately preceded their injury. The most common was the scissor kick jump (SKJ) performed in the rear court (19%), followed by lunges, both at the net (13%) and in the rear court (13%). When grouped together, lunges represented 26% of all injuries. Block jumps performed either laterally or to the rear accounted for 15%.

Some athletes provided additional context: injuries during landing on the non-dominant leg in the backhand side were common, especially when executing overhead forehand strokes. Others reported knee twisting due to traction with the floor, or contact injuries with a doubles partner.

Notably, 15% of ACL ruptures occurred immediately after being surprised by a deceptive shot from the opponent, highlighting the role of reactive movement.

Training vs. Match Play

ACL injuries were relatively balanced between training sessions (42%) and match play (55%). In both settings, most injuries happened during the final two-thirds of activity—suggesting a possible influence of fatigue: 80% of training-related and 61% of match-related injuries occurred in this latter part of the session.

Perceived Load and Surface Conditions

The majority of players rated their movement speed at the moment of injury as intermediate (31%) or high (54%). Only 25% reported that their foot was aligned with their intended direction of movement, while 31% said it was not. A substantial portion (40%) could not recall.

In terms of surface, 71% of injuries took place on wooden floors, and 22% on artificial surfaces. However, the study did not collect data on the actual exposure time to each surface type, limiting interpretation.

Conclusions from the Study

The study identified lunges and scissor kick jumps as the most frequent movements associated with ACL injuries in badminton. The rear court was the most common injury zone, with leg dominance influencing injury side: the dominant leg was more often injured on the forehand side, and the non-dominant leg on the backhand side. This pattern was especially pronounced among competitive players.

Situational elements such as deceptive opponent shots, fatigue, and fast movement speeds appeared relevant in many injury cases. The even distribution of injuries between training and competition suggests that risk is consistently present across contexts, though relative risk per hour was not calculable due to missing exposure data.

The authors conclude that more attention should be directed toward the technical execution of lunge and scissor kick jump movements. Given the specific mechanics observed in badminton—such as extended knee landings, lateral trunk lean, and rotational forces—there is a need for further biomechanical analysis and the development of badminton-specific prevention strategies, especially for movements in the rear court.