Alpine ski racing is known as a high‐risk sport; however, little is known on the health problems occurring at youth level. The purpose of this study was to investigate the prevalence of health problems in youth competitive alpine skiers with respect to sex, age, and season differences, to describe their severity and location and to assess the influence of biological maturation. Over a 12‐month period, 155 youth competitive alpine skiers around the growth spurt were prospectively monitored for health problems using the Oslo Sports Trauma Research Centre (OSTRC) questionnaire. These data were verified by supplemental interviews at the end. Biological maturation was estimated by a non‐invasive, anthropometric‐based assessment method. During competition season, 42.2% of the skiers suffered from health problems and 19.8% reported their problem being substantial. Females had significantly higher rates of acute and overuse injuries compared to males, while there was no sex difference in duration, severity, and time loss. Skiers of the category U15 showed higher prevalence of acute and overuse injuries than U14 skiers. During preparation season, health problem prevalence was substantially lower. The knee was found to be the most affected body part for both acute and overuse injuries. There was a direct association between the offset to the age at peak height velocity (APHV) and the occurrence and severity of acute injuries. In conclusion, youth competitive alpine skiers suffer from a large number of health problems. Since sex, age, and biological maturation are important, effective injury prevention should already start before reaching the APHV.

Purpose Prospective studies assessing the injuries occurring in elite competitive alpine skiers are lacking, and a full picture of all injuries, including those not requiring medical attention, is absent. Likewise, little is known about the sex-speciic injury risks and patterns of elite skiers throughout an entire season (i.e. an of-season preparation period and a competition period). Accordingly, this study investigated the injuries of a national team cohort with respect to season period and sex. Methods Over an entire season, all injuries occurring in 44 Swiss National Ski Team members (25 females and 19 males) were registered, regardless of whether they required medical attention. Skiers were prospectively monitored by the Oslo Sports Trauma Research Centre (OSTRC) questionnaire and by continuously updated team medical records. Finally, these data were used as a reference for supplemental interviews, in which the correctness and completeness of the prospective data were veriied. ResultsThe risk of sufering at least one injury during an entire season was 75.0% with a 95% conidence interval (73.1%, 76.9%) for traumatic injuries, and 52.3% (50.0%, 54.5%) for overuse injuries. Traumatic injuries concerned the head, lower leg and knee, while overuse injuries afected the lumbar spine, knee and hip. During the competition period, skiers were more prone to traumatic injuries, while during the of-season preparation period, skiers' risk was higher for overuse injuries. Over an entire season, there were no sex diferences. However, females were more vulnerable to traumatic injuries during the preparation period and overuse injuries during the competition period, while males had a higher risk for overuse injuries during the preparation period. Conclusions When prospectively registering injuries among elite competitive alpine skiers over an entire season, regardless of whether the injuries required medical attention, the injury risks were alarmingly high and substantially larger than those previously reported. Moreover, since injury risks and patterns are season period and sex dependent, it is strongly recommended that (1) injury registration focuses on both the of-season preparation period and the competition period and (2) prevention eforts are speciically tailored to the sex of the athletes. Level of evidence II.

Background/aimCompetitive alpine skiing is known to be associated with a high risk of traumatic knee injuries. However, little is known about the exact prevalence of knee overuse injuries and their associations with structural changes, particularly in youth skiers. Accordingly, the aim of the present study was to describe the overuse-related knee complaints and MRI abnormalities in a cohort of youth skiers around the growth spurt.Methods108 youth competitive alpine skiers aged 13–15 years were examined using an MRI of both knees, an interview on existing knee complaints and a physical examination. As a common baseline for these assessments, skiers were prospectively monitored by the use of the Oslo Sports Trauma Research Centre questionnaire on health problems over a period of 12 months preceding the major investigations.Results88.0% of the youth skiers showed at least one MRI abnormality in the knees. The most frequent findings were distal femoral cortical irregularities (63%), focal periphyseal oedema (FOPE) zones (25.0%) and cartilage lesions (18.5%). 47.2% of all skiers suffered from at least one overuse-related knee complaint during the 12 months preceding the MRI examination, mostly at the distal and proximal patellar tendon. However, despite a certain association with corresponding MRI abnormalities, the sensitivity of an MRI-based detection of such complaints was strongly limited.ConclusionYouth competitive alpine skiers suffer from a remarkably large number of knee overuse injuries. Accordingly, an effective prevention strategy should include a systematic screening of clinical complaints, ideally already starting around the growth spurt.

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Background: Alpine ski racing is known as a sport with unfavorable spinal loads and high rates of back overuse injuries at the elite level. However, little is known about overuse-related structural abnormalities occurring in the spine of youth athletes. Purpose: To describe the prevalence of abnormal magnetic resonance imaging (MRI) findings in the lumbar spine of youth competitive alpine skiers within the U16 category (under 16 years) with respect to sex, height growth, multifidus size, increasing age, and clinical relevance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 108 youth competitive alpine skiers aged 13 to 15 years underwent MRI examination of the lumbar spine and measurement of the multifidus cross-sectional area on a 3-T Magnetom Prisma scanner. Complementary assessments included the determination of anthropometrics and biological maturation. Athletes were classified as symptomatic when, pursuant to the Oslo Sports Trauma Research Center questionnaire on health problems, at least 1 substantial back overuse–related health problem episode had been registered during the 12 months before the MRI examination. Results: Of the analyzed youth skiers, 37.0% presented with ≥1 abnormal MRI finding in the lumbar spine. The most prevalent findings in both sexes were disc degeneration (23.1%), Schmorl nodes (19.4%), end plate changes (10.2%), and pars interarticularis anomalies (10.2%); the pars interarticularis anomalies occurred exclusively in males. A smaller relative lumbar multifidus cross-sectional area was related to more frequent occurrence of disc protrusions ( P = .018; R2 = 0.116) and end plate changes ( P = .024; R2 = 0.096). Overall, the occurrence of abnormal MRI findings in the lumbar spine increased with age ( P = .034; R2 = 0.054). Disc degeneration (particularly disc dehydration and disc protrusion) were significantly more prevalent in symptomatic versus asymptomatic athletes ( P < .05 for all). Conclusion: As early as age 15 years or younger, competitive alpine skiers demonstrated distinct overuse-related structural abnormalities in the lumbar spine, with some of them being clinically relevant and restrictive of sports participation. As sex, height growth, multifidus size, and increasing age seem to play an important role for the occurrence of such abnormalities, considering these factors might be essential for prevention.

To compare the prevalence of distal femoral cortical irregularities (DFCIs) at different tendon attachment sites in youth competitive alpine skiers with that in young adults. Materials and Methods:In this secondary analysis of a prospective trial, unenhanced 3-T knee MRI scans obtained in youth competitive alpine skiers were compared with images in control participants of the same age from 2014 to 2019 (Cantonal Ethics Committee Zurich registry number: KEK-ZH-2017-01395) for presence of DFCIs at the femoral attachment of the medial head of the gastrocnemius muscle (MHG) and/or lateral head of the gastrocnemius muscle (LHG) and adductor magnus tendon by two radiologists. DFCI size and tendon attachment position were measured. Tendon attachment position and associated MRI findings (meniscus, cartilage, bone marrow edema, joint effusion, ligaments, tendons) were examined for an association with DFCI. Pearson x 2 , Student t test, logistic regression, and k statistics were applied.Results: Unilateral knee MRI scans obtained in 105 skiers (mean age, 14.8 years 6 0.6 [standard deviation]; 66 boys) and in 105 control participants (mean age, 14.6 years 6 0.5; 59 boys) were evaluated. DFCIs were found in 61 of 105 skiers (58%; 95% confidence interval [CI]: 48.5%, 67.2%) compared with 28 of 105 control participants (27%; 95% CI: 18.9%, 35.7%) (P , .001). Two skiers had more than one DFCI. Distribution of DFCIs for skiers and control participants was 60 of 63 (95.2%) and 26 of 28 (92.8%) at the MHG, three of 63 (4.8%) and one of 28 (3.6%) at the LHG, and zero of 63 (0%) and one of 28 (3.6%) at the adductor magnus attachment site, respectively. Interreader agreement was almost perfect (k = 0.87; 95% CI: 0.80, 0.93). The mean size of MHG-related DFCIs in skiers (3.7 mm) was not different compared to the size of those in control participants (3.4 mm) (P = .32), nor was a difference found for the MHG tendon attachment position in knees with DFCI (63.9 mm vs 63.0 mm, P = .83) or without DFCI (63.6 mm vs 62.8 mm, P = .86). Regarding associated MRI findings, increased signal intensity of the MHG tendon showed a significant association with MHG-related DFCI in both groups (P = .01 for both). Conclusion:A distal femoral cortical irregularity at the attachment sites of tendons was a frequent incidental finding on knee MRI scans, with an increased prevalence in youth competitive alpine skiers.

Background: Ski touring is an outdoor sport with growing popularity in alpine countries. Information about injuries in ski touring is limited. Purpose: To determine injury rates, mechanisms, causes, and risk factors in ski touring. Study Design: Descriptive epidemiology study. Methods: Between November 2015 and May 2016, a total of 191 participants from the Alps region were prospectively tracked via personalized online questionnaires. Injury rates were calculated per 1000 hours of sports exposure. Risk factors were assessed per multivariate logistic regression analysis. Results: A total of 3900 ski tours were performed, with 10,955 hours and 4,108,503 m in height ascension (uphill) recorded. The overall injury rate was 2.5 injuries per 1000 hours of ski touring. A total of 27 injury-events were reported, of which 18 (67%) were classified as mild, 7 (26%) as moderate, and 2 (7%) as severe. Hands (28%) and knees (16%) were the most commonly involved anatomic regions. Most injuries were limited to the soft tissue, such as bruises (31%) and abrasions (18%). Significantly more injuries happened during the descent (n = 17; 63%) than during the ascent (n = 6; 22%) (odds ratio, 5.96; P = .004), while poor weather conditions, icy surface, and inattentiveness were the most often reported reasons for injury. Sidecountry ski touring was identified as the only significant independent risk factor for injury ( P < .001). Conclusion: In this prospective injury surveillance study, the majority of ski touring injuries were mild and limited to the soft tissue. Ski touring injuries were more likely to happen during the descent of a tour, and sidecountry ski touring was the only significant independent risk factor for injury. Bad weather, icy surface, and inattentiveness were found to be the leading causes for an injury-event in this study.

The impact of extensive loads on the cartilage of the proximal interphalangeal-(PIP) and distal interphalangeal (DIP) joints of the fingers in elite sport climbers are relatively unknown. The purpose of this study was to investigate the changes in the cartilage of the PIP and DIP joints as well as the existence of osteophytes, in fingers of elite sport climbers with a minimum of 15 years of climbing history. Thirty-one elite male sport climbers and 20 male non-climbers volunteered for the current cross-sectional observation. By means of ultrasonography, the thickness of cartilage of the PIP and DIP joints in a sagittal and frontal plane of the digits II to V of both hands, as well as the existence of osteophytes on the dorsal aspect of the phalanges were assessed. The main results were: (1) cartilage thickness revealed to be significantly greater in climbers than non-climbers,; (2) larger cartilage thickness differences were found at the DIP joints; (3) while climbers showed a substantial occurrence of osteophytes with highest relative frequencies at Dig III, in the group of non-climbers no osteophytes were observed; (4) small to moderate correlations were found between the cartilage and osteophyte thickness of climbers at the PIP and DIP joints and Dig III. In conclusion, an accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career may induce degenerative changes at the PIP and DIP joints.