Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review

Abstract

The purpose of the present review was to: 1) provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL) injury in alpine ski racing; and 2) provide an overview of what is known pertaining to ACL reinjury and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers) were found to be at high risk for knee injuries, and ACL tears were the most frequent diagnosis. Three primary ACL injury mechanism were identified that involved tibial internal rotation and anteriorly directed shear forces from ski equipment and the environment. While trunk muscle strength imbalance and genetics were found to be predictive of ACL injuries in development-level skiers, there was limited scientific data on ACL injury risk factors among elite skiers. Based on expert opinion, research on injury risk factors should focus on equipment design, course settings/speed, and athlete factors (eg, fitness). While skiers seem to make a successful recovery following ACL injury, there may be persistent neuromuscular deficits. Future research efforts should be directed toward prospective studies on ACL injury/reinjury prevention in both male and female skiers and toward the effects of knee injury on long-term health outcomes, such as the early development of osteoarthritis. International collaborations may be necessary to generate sufficient statistical power for ACL injury/reinjury prevention research in alpine ski racing.

Long-Term Athletic Development in Youth Alpine Ski Racing: The Effect of Physical Fitness, Ski Racing Technique, Anthropometrics and Biological Maturity Status on Injuries

“…In alpine ski racing, increased knee valgus loading often leads to neurophysiological injuries (Spörri et al, 2017 ). Three mechanisms were identified for ACL injuries, among which the dynamic snowplow and the slip catch can be partly attributed to increased knee valgus loading (Bere et al, 2011 ; Jordan et al, 2017 ). In the present study, only one male athlete sustained an ACL injury; however, the knee was the most affected body part by traumatic and overuse injuries, and ligament injuries in the knee frequently occurred.…”

Ski Lesions Around the Knee: A Literature Review

“…In [7,8], Jordan et al made a review in which they report literature finding that only 55% of alpine skiing athletes are able to return to their preinjury level after an ACL rupture. They also support the result we have found that in this group of skiers there is no sex difference in ACL injury rates.…”

“…In [12], and also in two interesting reviews [7,21], proposed injury mechanisms are explained; a summary of this is of high interest for a better understanding of knee injuries in skiers:…”

“…This happens during a turn, after losing contact with the snow by the outer ski; when it recovers the ski catches the edge causing rapid flexion, internal rotation, and valgus. A very important reported fact is that in 100% of slip-catch ACL injuries in athletes ski bindings do not release or are release after the injury took place [7].…”

“…These two mechanisms are believed to be related with the use of more aggressive and smaller turn radius skis like the ones used in slalom races; even some authors suggest that carving skies (shorter, wider in tip and tail, easier to turn) may augment the injury risk as their design may increase kinetic energy in slopes [7], although this last point is controversial [12].…”