From the Guidelines
The Anterior Cruciate Ligament (ACL) is commonly injured in skiing due to the unique biomechanical forces experienced during the sport, with females being two to eight times more likely to sustain an ACL injury than their male counterparts. The mechanisms of ACL injuries in skiing are multifactorial, involving the interaction of equipment, technique, and physical conditioning. ACL injuries typically occur when a skier lands from a jump with the knee extended, experiences a sudden deceleration while turning, or falls with the knee twisted while the ski remains fixed in the snow 1. Some key factors that contribute to the high incidence of ACL injuries in skiing include:
- The rigid ski boot, which secures the ankle but transfers rotational forces to the knee joint, making it vulnerable
- The "phantom foot" phenomenon, where a skier falls backward, causing internal rotation of the tibia while the knee is flexed and the weight shifts to the inside edge of the ski tail
- Modern ski equipment, particularly the increased stiffness of boots and skis, which has paradoxically increased ACL injury risk by limiting ankle movement while allowing greater forces to be transmitted to the knee
- Risk factors such as fatigue, improper binding settings, poor conditioning, and skiing in difficult conditions Prevention strategies include proper equipment adjustment, specific muscle strengthening (particularly quadriceps and hamstrings), learning proper falling techniques, and maintaining awareness of skiing conditions and personal limitations, as highlighted in the practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus 1.
From the Research
Causes of ACL Injuries in Skiing
- The anterior cruciate ligament (ACL) is commonly injured in skiing due to various factors, including the mechanics of the sport and the equipment used 2.
- Three primary ACL injury mechanisms have been identified, involving tibial internal rotation and anteriorly directed shear forces from ski equipment and the environment 2.
- Trunk muscle strength imbalance and genetics have been found to be predictive of ACL injuries in development-level skiers, although there is limited scientific data on ACL injury risk factors among elite skiers 2.
Risk Factors for ACL Injuries
- Alpine ski racers are at high risk for knee injuries, with ACL tears being the most frequent diagnosis 2, 3.
- The risk of ACL injury is influenced by factors such as equipment design, course settings, and athlete factors (e.g., fitness) 2.
- Combined injuries to the ACL and medial collateral ligament (MCL) can occur, although these are relatively rare 3.
Prevention and Treatment of ACL Injuries
- Research on injury risk factors should focus on equipment design, course settings, and athlete factors to develop effective prevention strategies 2.
- Treatment options for ACL tears include nonoperative management (e.g., physical therapy, bracing) and operative treatment (e.g., ACL reconstruction) 4, 5.
- Rehabilitation protocols after ACL repair techniques are still being developed, and more research is needed to determine the most effective approaches 5.
Historical Context of ACL Injuries in Skiing
- ACL injuries have been a common problem in skiing for several decades, with early studies highlighting the need for further research into the causes and prevention of these injuries 6.
- The incidence of ACL injuries in skiing has been reported to be high, with some ski clinics diagnosing an average of one ACL injury per day over the course of a ski season 6.