Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral contraceptive use and previous knee injuries. Menstrual history data were used to group subjects into either preovulatory or postovulatory phases of menstrual cycle. Our findings suggest that oral contraceptive use did not show any protective effect against ACL injuries nor did self-reported previous knee injuries show any association with ACL injury rate in recreational alpine skiing. Analysis of menstrual history data revealed that recreational skiers in the preovulatory phase were significantly more likely to sustain an ACL injury than were skiers in the postovulatory phase.

In recreational alpine skiing, ACL injury risk is 3 times greater in females. However, since the introduction of carving skis ACL injury risk seems to have decreased. No study has yet investigated the distribution of ACL injury mechanisms in male and female carving skiers. Therefore, the aim of the study was to investigate potential gender specific differences of ACL injury mechanisms and related factors among carving skiers. In total, 220 recreational carving skiers (59 males and 161 females) suffering from an ACL injury volunteered for this study. Demographic data, skiing ability, equipment related and environmental factors, circumstances and causes for the fall, and type of fall (injury mechanisms) were collected by questionnaire. The forward twisting fall is the most reported ACL injury mechanism in both gender (p=0.672) accounting for 54% of all injuries, although male and female skiers differed significantly with regard to circumstances of fall (p=0.001) and actions when ACL injury occurred (p=0.04). Bindings not releasing at the time point of accident occurred 2.6 times more with females than with males (p=0.005). The forward twisting fall seems to have become the dominant ACL injury mechanism both in male and female recreational skiers since the introduction of carving skis.

Female skiers showed a 2-fold higher risk of suffering from an ACL rupture on their nondominant leg. Therefore, leg dominance seems to be a risk factor for noncontact ACL injuries in female recreational skiers.

Among this cohort of ACL-injured skiers, failure of binding release was significantly associated with female sex, a slow perceived speed at the moment of injury and complete rupture of the ACL.

While ACL injury mechanisms in skiers using traditional skis are well studied, no study has yet investigated the distribution of injury mechanisms in carving skiers. In traditional skiers, the backward twisting fall seems to be the dominant injury mechanism, especially in female skiers. Female recreational skiers have a threefold higher risk to sustain an ACL injury than male skiers; therefore, it is important to determine if carving skis influence the distribution of injury mechanisms and the related frequencies of ACL injuries in female skiers. We investigated the frequencies of injury mechanisms and related factors in 65 ACL-injured female carving skiers by questionnaire. The forward twisting fall was the most reported ACL injury mechanism with about 51%, followed by the backward twisting fall within 29% of cases. Catching an edge of the ski (59 vs. 24%, P = 0.03) when executing turns (69 vs. 41%, P = 0.053) was a more frequent cause for forward twisting falls than for the other types of falling. While 29% of bindings released during a forward twisting fall, only 3.1% released during the remaining mechanisms. In contrast to traditional skiers, the forward twisting fall was the dominant injury mechanism in female carving skiers with ACL injury.

BackgroundFlight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria.MethodsAmong a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire.ResultsFor helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8–30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1–7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06–3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48–9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21–4.31, p = 0.011) to be significantly associated with neck pain.ConclusionsThe 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.

In alpine skiing, the knee represents the dominant injury location with marked gender differences. Snow, slope and weather conditions as well as altitude and low temperatures are thought to influence the prevalence of knee injuries. Therefore, ski patrol injury reports were used to compare gender-specific prevalence of knee injuries with regard to several environmental factors including the actual air temperatures. A total of 1039 non-contact knee injuries were reported with a corresponding prevalence of knee injuries of 44.4% (males: 30.1%; females: 57.4%). Temperature quartiles of all recorded injuries were calculated to compare gender-specific prevalence of knee injury with regard to temperatures. Comparing the first quartile (mean temperature -11°C) with the fourth quartile (mean temperature +3°C), the prevalence of knee injury in female skiers was higher at low ambient temperatures (61% vs 50%, odds ratio: 1.60, 95% confidence interval: 1.16-2.22; P=0.005) while no such association was found for male skiers. Additionally, knee-injured females showed a twofold prevalence when skiing during snowfall compared with females with other injuries (15.4% vs 8.6%; P=0.001). No other environmental factor showed a significant association with the gender-specific prevalence of knee injury. In conclusion, low ambient temperature and snowfall are important environmental risk factors for knee injuries in female skiers.

The study evaluated incidences and potential differences of traumatic and nontraumatic fatalities among recreational skiers and snowboarders on Austrian ski slopes within a 10-year analysis. Within this retrospective study, data were collected by the Federal Ministry of the Interior. Data comprised all traumatic and nontraumatic deaths on Austrian ski slopes which occurred between the 2008/09 and 2017/18 winter seasons. Age, sex, nationality, gear used, altitude, slope difficulty, accident cause, primary cause of death and helmet use were collected at the death scene. Incidence of fatalities was calculated based on number of skier days. In total, 369 fatalities, with an average of 36.9 ± 7.9 fatalities per year, were registered. The yearly incidence of traumatic and nontraumatic deaths decreased by 25.8% and 40.1% during the 10-year time period, leading to an evaluated mean incidence of 0.70 deaths per million skier days, with an incidence of 0.36 traumatic deaths and 0.34 nontraumatic deaths per million skier days. Incidences of both traumatic and nontraumatic deaths decreased during the 10-year analysis, representing death as a rare event on Austrian ski slopes. However, adequate prevention measures to reduce potential risk factors to further reduce the mortality risk on ski slopes are needed.